Individual
TY AUSTIN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
12385 SW 125TH CT, MIAMI, FL 33186-5488
(435) 650-8079
Mailing address
12385 SW 125TH CT, MIAMI, FL 33186-5488
(435) 650-8079
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
OS17192
FL
Other
Enumeration date
04/12/2019
Last updated
12/17/2020
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