MEDICARE: KWISA O DAVIS MD

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	208000000X	Pediatrics Physician	ME91503	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427068196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KWISA O DAVIS MD

Provider Business Mailing Address
First Line	:	PO BOX 152557
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33684-2557
Country	:	US
Telephone Number	:	813-239-3262
Fax Number	:	813-237-6941

Provider Business Practice Location Address
First Line	:	7108 N NEBRASKA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-4915
Country	:	US
Telephone Number	:	813-239-3262
Fax Number	:	813-237-6941

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	06/19/2012

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Directions to “ KWISA O DAVIS MD” Practice Location

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