Provider Demographics
NPI:1720443807
Name:DAVISON, PATRICK EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:EDWARD
Last Name:DAVISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SE TIFFANY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7521
Mailing Address - Country:US
Mailing Address - Phone:772-398-1990
Mailing Address - Fax:772-398-1925
Practice Address - Street 1:1800 SE TIFFANY AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7521
Practice Address - Country:US
Practice Address - Phone:772-398-1990
Practice Address - Fax:772-398-1925
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16018207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine