# PARADISE COAST PAVILION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vein Care Pavilion of Florida
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598916611
- **Authorized official:** DR. KEITH L DAVIS M.D. (PARTNER)
- **Authorized official phone:** (706) 854-3333

## Contact information

- **Practice address:** 9400 GLADIOLUS DR, SUITE 105, FORT MYERS, FL 33908-6699
- **Practice address phone:** (239) 454-4800
- **Mailing address:** 447 N BELAIR RD STE 103, EVANS, GA 30809-3091
- **Mailing address phone:** (706) 854-3333
- **Mailing address fax:** (706) 854-2059

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208200000X | Plastic Surgery Physician | ME23742 | FL | — |
| 2086S0129X | Vascular Surgery Physician | ME102815 | FL | Yes |

## Other

- **Enumeration date:** 10/07/2008
- **Last updated:** 10/07/2008