MEDICARE: ERIC W DAVIS

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	172A00000X	Driver

General Provider Information

NPI Number	:	1295207850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC W DAVIS

Provider Business Mailing Address
First Line	:	7481 W OAKLAND PARK BLVD STE 302G
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-4961
Country	:	US
Telephone Number	:	954-249-0334
Fax Number	:	954-451-5038

Provider Business Practice Location Address
First Line	:	7481 W OAKLAND PARK BLVD STE 302G
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-4961
Country	:	US
Telephone Number	:	954-497-3020
Fax Number	:	954-451-5038

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

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	12/20/2018

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Directions to “ ERIC W DAVIS ” Practice Location

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