=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972804995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYNTHIA DAVIS MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2010
-----------------------------------------------------
Last Update Date | 01/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 779 MEDICAL DR SUITE 3
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34223-5234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-475-5002
-----------------------------------------------------
Fax | 941-475-6913
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1904
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34295-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-475-5002
-----------------------------------------------------
Fax | 941-475-6913
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CYNTHIA DAVIS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 941-475-5002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | ME0067506
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------