MEDICARE: DR. LESLEE SIMONAH 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	ME86495	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	080192922	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	213992	OTHER	FL	HEALTHEASE HEALTHY KIDS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0279269-94	OTHER	FL	MEDIPASS
4	57903	OTHER	FL	BCBS (OUT OF NETWORK)
5	01-10038	OTHER	FL	UNITED HEALTHY KIDS
6	01-10038	OTHER	FL	UNITED

General Provider Information

NPI Number	:	1992818397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLEE SIMONAH DAVIS M.D.

Provider Business Mailing Address
First Line	:	2868 STAGS LEAP DR
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8346
Country	:	US
Telephone Number	:	386-232-4792
Fax Number	:

Provider Business Practice Location Address
First Line	:	2868 STAGS LEAP DR
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8346
Country	:	US
Telephone Number	:	386-232-4792
Fax Number	:

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. LESLEE SIMONAH DAVIS M.D.” Practice Location

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