MEDICARE: DR. JEFFREY M DAVIS M.D.

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	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	ME42588	FL

General Provider Information

NPI Number	:	1538165428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY M DAVIS M.D.

Provider Business Mailing Address
First Line	:	4642 DARLINGTON RD
Second Line	:
City	:	HOLIDAY
State	:	FL
Zip	:	34690-3906
Country	:	US
Telephone Number	:	727-938-2474
Fax Number	:	727-934-1579

Provider Business Practice Location Address
First Line	:	4642 DARLINGTON RD
Second Line	:
City	:	HOLIDAY
State	:	FL
Zip	:	34690-3906
Country	:	US
Telephone Number	:	727-938-2474
Fax Number	:	727-934-1579

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	01/30/2013

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