Individual
KWISA O DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7108 N NEBRASKA AVE, TAMPA, FL 33604-4915
(813) 239-3262
(813) 237-6941
Mailing address
PO BOX 152557, TAMPA, FL 33684-2557
(813) 239-3262
(813) 237-6941
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME91503
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052602906
—
FL
Enumeration date
08/08/2006
Last updated
06/19/2012
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