Active NPI
Mathieu Davis Jr.
- Phlebotomy Technician
- Lake Mary, FL
National Provider Identifier
1073401014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Phlebotomy Technician
- Practice address
- 3005 W Lake Mary Blvd Ste 111
Lake Mary, FL 32746-6001 - Phone
- (407) 205-2057
- NPI assigned
- Jun 26, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Phlebotomy Technician | 246RP1900X | Primary |
Addresses
Primary practice location
3005 W Lake Mary Blvd Ste 111
Lake Mary, FL 32746-6001
Mailing address
3005 W Lake Mary Blvd Ste 111
Lake Mary, FL 32746-6001
Phone (407) 205-2057
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1750896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750896000000",
"number": "1073401014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3005 W LAKE MARY BLVD STE 111",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327466001",
"telephone_number": "407-205-2057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3005 W LAKE MARY BLVD STE 111",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327466001",
"telephone_number": "407-205-2057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "MATHIEU",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-06-26",
"last_updated": "2025-06-26",
"certification_date": "2025-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "246RP1900X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Phlebotomy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Mary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.