MEDICARE: LENDOL L. 'TAD' DAVIS M.D.

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	207VM0101X	Maternal & Fetal Medicine Physician	E0621	TX
2	207VG0400X	Gynecology Physician	E6021	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255336855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENDOL L. 'TAD' DAVIS M.D.

Provider Business Mailing Address
First Line	:	1902 S IH 35
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-3628
Country	:	US
Telephone Number	:	512-443-9595
Fax Number	:

Provider Business Practice Location Address
First Line	:	1902 S IH 35
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-3628
Country	:	US
Telephone Number	:	512-443-9595
Fax Number	:

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	06/12/2024

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