MEDICARE: DR. MARK L DAVIS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	5101012747	MI
2	207X00000X	Orthopaedic Surgery Physician	007480	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200C313650	OTHER	MI	BCBS MI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	200C31650	OTHER	MI	BLUECARE NETWORK
4	300040412	OTHER	MI	TRICARE
5	200000001852	OTHER	MI	PHYSICIANS HEALTH PLAN
6	2053302675	OTHER	MI	BLUE SHIELD

General Provider Information

NPI Number	:	1083618615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK L DAVIS D.O.

Provider Business Mailing Address
First Line	:	3269 N STOCKTON HILL RD
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409-3619
Country	:	US
Telephone Number	:	928-757-2101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1739 E BEVERLY AVE STE 102
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409-3593
Country	:	US
Telephone Number	:	928-681-8693
Fax Number	:	928-681-8694

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	04/11/2022

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Directions to “ DR. MARK L DAVIS D.O.” Practice Location

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