Provider Demographics
NPI:1386609642
Name:DAVEY, DIANE DAVIS (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:DAVIS
Last Name:DAVEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6850 LAKE NONA BLVD
Mailing Address - Street 2:COLLEGE OF MEDICINE, HEALTH SCIENCES CAMPUS, 4TH FLOOR
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7408
Mailing Address - Country:US
Mailing Address - Phone:407-266-1100
Mailing Address - Fax:407-266-1199
Practice Address - Street 1:5201 RAYMOND ST
Practice Address - Street 2:ORLANDO VAMC, LABORATORY
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:407-629-1599
Practice Address - Fax:407-599-1387
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY25798207ZC0500X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64257983Medicaid
0054550Medicare ID - Type Unspecified
KY64257983Medicaid