Organization
PARADISE COAST PAVILION, LLC
Active
Other names
Vein Care Pavilion of Florida
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH L DAVIS M.D. (PARTNER)
(706) 854-3333
Entity
Organization
Contact information
Practice address
9400 GLADIOLUS DR, SUITE 105, FORT MYERS, FL 33908-6699
(239) 454-4800
Mailing address
447 N BELAIR RD STE 103, EVANS, GA 30809-3091
(706) 854-3333
(706) 854-2059
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
ME23742
FL
2086S0129X
Vascular Surgery Physician
Primary
ME102815
FL
Other
Enumeration date
10/07/2008
Last updated
10/07/2008
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