Individual
DIMITRY SAMUEL DAVYDOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-0001
(352) 265-0301
Mailing address
PO BOX 100183, GAINESVILLE, FL 32610-0183
(352) 265-4357
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
ME165986
FL
2084P0800X
Psychiatry Physician
Primary
ME165986
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0257115
L&I
WA
05
—
1619911930
—
WA
Enumeration date
06/16/2006
Last updated
12/29/2023
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