MEDICARE: DR. GWYNETH A. 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	207Q00000X	Family Medicine Physician	ME84651	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

General Provider Information

NPI Number	:	1700848926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GWYNETH A. DAVIS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10744
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33757-8744
Country	:	US
Telephone Number	:	727-532-0002
Fax Number	:	727-266-4928

Provider Business Practice Location Address
First Line	:	1601 W TIMBERLANE DR
Second Line	:	SUITE 300
City	:	PLANT CITY
State	:	FL
Zip	:	33566-0957
Country	:	US
Telephone Number	:	813-754-4611
Fax Number	:	813-443-8169

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	01/23/2015

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