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1427091339

NPI Code Detail

MEDICARE: DR. RANDALL THOMAS DAVIS M.D.

MEDICARE: DR. RANDALL THOMAS 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	207RX0202X	Medical Oncology Physician	J0469	TX
2	207RH0003X	Hematology & Oncology Physician	J0469	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8R1422	OTHER	TX	BLUE CROSS OF TEXAS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427091339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL THOMAS DAVIS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 911230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-1230
Country	:	US
Telephone Number	:	972-997-8000
Fax Number	:	972-437-9605

Provider Business Practice Location Address
First Line	:	1609 HOSPITAL PKWY
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6920
Country	:	US
Telephone Number	:	817-359-9096
Fax Number	:	817-354-8969

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/12/2021

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Directions to “ DR. RANDALL THOMAS DAVIS M.D.” Practice Location

Language	Start Address	Practice Location

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