Basic Information
| Provider Information | |||||||||
| NPI: | 1184049827 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2326 S CONGRESS AVE | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334067652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614335577 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2326 S CONGRESS AVE | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334067652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614335577 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2014 | ||||||||
| LastUpdateDate: | 09/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | PO3642 | FL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | PO3642 | FL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.