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General NPI Number Information
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NPI Number | 1902987902
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Entity Type | Individual
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Provider Name | DEMEKISA SIDAMO DAVIS D.O.M.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 5301 GULFPORT BLVD
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City | GULFPORT
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State | FL
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Zip | 33707
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Country | US
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Telephone | 727-642-6470
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Fax | 727-866-8575
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Provider Business Mailing Address
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Address Line | 5301 GULFPORT BLVD.
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City | GULFPORT
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State | FL
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Zip | 33707
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Country | US
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Telephone | 727-642-6470
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Fax | 727-866-8575
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP1210
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State | ID
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