1386056083 NPI number — DR. DOUGLAS RAY DAVIS MD

Table of content: DR. DOUGLAS RAY DAVIS MD (NPI 1386056083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386056083 NPI number — DR. DOUGLAS RAY DAVIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
DOUGLAS
Provider Middle Name:
RAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1386056083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 S SANTA FE, SUITE 300
Provider Second Line Business Mailing Address:
NEUROLOGY DEPARTMENT
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-452-6911
Provider Business Mailing Address Fax Number:
785-452-7807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 S SANTA FE, SUITE 300
Provider Second Line Business Practice Location Address:
NEUROLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
SALINA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-452-6911
Provider Business Practice Location Address Fax Number:
785-452-7807
Provider Enumeration Date:
05/29/2014

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: 2084N0400X , with the licence number:  04-40824 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201203330A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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