Paradise Coast Pavilion, LLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

ME102815 Issued in FL

Legal business name

PARADISE COAST PAVILION, LLC

Practice address

9400 Gladiolus Dr
Suite 105
Fort Myers, FL 33908-6699

Phone

(239) 454-4800

NPI assigned

Oct 7, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Keith L Davis, M.D.

Title

Partner

Phone

(706) 854-3333

Specialties & licenses 2

Addresses

Other names 1

• Vein Care Pavilion of Florida Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1598916611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "447 N BELAIR RD STE 103",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093091",
            "telephone_number": "706-854-3333",
            "fax_number": "706-854-2059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9400 GLADIOLUS DR",
            "address_2": "SUITE 105",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339086699",
            "telephone_number": "239-454-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADISE COAST PAVILION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "706-854-3333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "FL",
            "license": "ME23742",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": "ME102815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vein Care Pavilion of Florida",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dena Paniccia, LCSW
• Veronica Gennadievna Papavero, M.D.
• Brooke M Pape, AUD
• Heidi Denise Papesh, NURSE PRACTITIONER
• Eduardo Daniel Parada
• Irma Victoria Parajon
• Paramount Home Health Services, LLC
• Paramount Surgery Center, LLC
• Alexander Paraschuk, DO
• Julianne Parasiliti, PT, DPT

• Vascular Surgery Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Vascular Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.