1295719623 NPI number — DR. BURIS PARKER DAVIS, JR. D.M.D.

Table of content: TUONG VAN T TRAN RDH (NPI 1538450572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295719623 NPI number — DR. BURIS PARKER DAVIS, JR. D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS, JR.
Provider First Name:
BURIS
Provider Middle Name:
PARKER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295719623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3367 COUNTY ROAD 73
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36353-7084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-889-4537
Provider Business Mailing Address Fax Number:
334-792-9336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 HEALTHWEST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36303-1942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-792-2880
Provider Business Practice Location Address Fax Number:
334-792-9336
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  2989 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000001636 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 464392 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51091607 . This is a "BCBSAL DOTHAN OFFICE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51097734 . This is a "BCBSAL ENTERPRISE OFFICE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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