1063498566 NPI number — WILLIAM EUGENE DAVIS JR. M.D.

Table of content: WILLIAM EUGENE DAVIS JR. M.D. (NPI 1063498566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063498566 NPI number — WILLIAM EUGENE DAVIS JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
WILLIAM
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
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:
1063498566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 UNIVERSITY AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-5945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-401-1950
Provider Business Mailing Address Fax Number:
515-401-1955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
WEST DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50266-5945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-401-1950
Provider Business Practice Location Address Fax Number:
515-401-1955
Provider Enumeration Date:
12/16/2005

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: 207L00000X , with the licence number:  31229 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 06009 . This is a "TRICARE PROVIDER #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 050045048 . This is a "RAILROAD MEDICARE NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IA0168 . This is a "JOHN DEERE PROVIDER #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 54810 . This is a "BLUE SHIELD PROVIDER #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0141622 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5677 . This is a "MIDLANDS PROVIDER #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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