Individual
DR. RICHARD PERRY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-7000
Mailing address
PO BOX 2400, MELBOURNE, FL 32902-2400
(877) 448-8675
(772) 621-3184
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.054799
IL
2085R0202X
Diagnostic Radiology Physician
Primary
ME120255
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036.1275555
STATE OF ILLINOIS, DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
01
—
125.054799
TEMPORARY MEDICAL LICENSE
IL
Enumeration date
04/20/2009
Last updated
06/27/2014
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