MEDICARE: RAUL DAVID DAVILA 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	207L00000X	Anesthesiology Physician	ME79321	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME79321	FL

General Provider Information

NPI Number	:	1972532968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAUL DAVID DAVILA MD

Provider Business Mailing Address
First Line	:	8192 COLLEGE PKWY STE A18
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-5198
Country	:	US
Telephone Number	:	239-454-0418
Fax Number	:	239-454-0419

Provider Business Practice Location Address
First Line	:	8192 COLLEGE PKWY STE A18
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-5198
Country	:	US
Telephone Number	:	239-454-0418
Fax Number	:	239-454-0419

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	01/19/2018

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