MEDICARE: LOWELL SCOTT DAVIS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	OS9166	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	OS9166	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44147	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114907409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOWELL SCOTT DAVIS DO

Provider Business Mailing Address
First Line	:	PO BOX 817737
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33081-1737
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1951 SW 172ND AVE
Second Line	:	#314
City	:	MIRAMAR
State	:	FL
Zip	:	33029-5593
Country	:	US
Telephone Number	:	954-447-5206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	01/19/2011

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Directions to “ LOWELL SCOTT DAVIS DO” Practice Location

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