Provider Demographics
NPI:1386624393
Name:DAVIS, GAITHER G (MD)
Entity type:Individual
Prefix:MR
First Name:GAITHER
Middle Name:G
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 1:13910 LAKESHORE BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-862-3588
Mailing Address - Fax:727-868-0414
Practice Address - Street 1:13910 LAKESHORE BLVD
Practice Address - Street 2:STE 120
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-862-3588
Practice Address - Fax:727-862-3588
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2024-07-31
Deactivation Date:2024-06-28
Deactivation Code:
Reactivation Date:2024-07-31
Provider Licenses
StateLicense IDTaxonomies
FLME48976207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02731Medicare ID - Type Unspecified
D50630Medicare UPIN