Provider Demographics
NPI:1992721021
Name:DAVIS, REGINALD J (MD)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7331 COLLEGE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5524
Mailing Address - Country:US
Mailing Address - Phone:239-337-2003
Mailing Address - Fax:239-337-3168
Practice Address - Street 1:7331 COLLEGE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5524
Practice Address - Country:US
Practice Address - Phone:239-337-2003
Practice Address - Fax:239-337-3168
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030060207T00000X
FLME122117207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408761500Medicaid
MD712L/188757YBPGMedicare PIN
MD408761500Medicaid
MD703LM032Medicare PIN