Provider Demographics
NPI:1063780401
Name:DAVIS, JAMES WATSON RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES WATSON
Middle Name:RICHARD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 EXECUTIVE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32399-6512
Mailing Address - Country:US
Mailing Address - Phone:850-488-4222
Mailing Address - Fax:
Practice Address - Street 1:2406 TROLAND RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0934
Practice Address - Country:US
Practice Address - Phone:850-284-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 39287207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology