MEDICARE: MARK S. DAVIDS, DPM

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	213E00000X	Podiatrist	PO1572	FL

General Provider Information

NPI Number	:	1184884314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK S. DAVIDS, DPM

Provider Business Mailing Address
First Line	:	850 N STONE ST
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 N STONE ST
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3256
Country	:	US
Telephone Number	:	386-736-7636
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK S. DAVIDS
Credential	:	DPM
Telephone Number	:	386-736-7636

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	06/11/2008

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