Provider Demographics
NPI:1992818397
Name:DAVIS, LESLEE SIMONAH (MD)
Entity type:Individual
Prefix:DR
First Name:LESLEE
Middle Name:SIMONAH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2868 STAGS LEAP DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8346
Mailing Address - Country:US
Mailing Address - Phone:386-232-4792
Mailing Address - Fax:
Practice Address - Street 1:2868 STAGS LEAP DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8346
Practice Address - Country:US
Practice Address - Phone:386-232-4792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL213992OtherHEALTHEASE HEALTHY KIDS
FL2660296Medicaid
FL0279269-94OtherMEDIPASS
FL57903OtherBCBS (OUT OF NETWORK)
FL01-10038OtherUNITED HEALTHY KIDS
FL01-10038OtherUNITED
FL080192922OtherRAILROAD MEDICARE
FL0279269-94OtherMEDIPASS
FL57903ZMedicare ID - Type Unspecified