MEDICARE: DAVISHIRE DERMATOLOGY LLC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1811648066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVISHIRE DERMATOLOGY LLC

Provider Business Mailing Address
First Line	:	1900 PATTERSON ST STE 205
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2165
Country	:	US
Telephone Number	:	615-329-0341
Fax Number	:	615-329-3056

Provider Business Practice Location Address
First Line	:	1900 PATTERSON ST STE 205
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2165
Country	:	US
Telephone Number	:	615-329-0341
Fax Number	:	615-329-3056

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID H HOROWITZ
Credential	:	MD
Telephone Number	:	615-329-0341

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	01/10/2022

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