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NPI Code Detail

MEDICARE: CHARLES M DAVIS M.D.

MEDICARE: CHARLES M 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
12085R0202XDiagnostic Radiology PhysicianMMD5688MDSC
22085R0202XDiagnostic Radiology Physician056888SC

Other Identifiers

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

General Provider Information

NPI Number : 1447240171
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES M DAVIS M.D.
Provider Business Mailing Address
First Line : 1770 IOWA AVE STE 280
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-7401
Country : US
Telephone Number : 951-786-0801
Fax Number :
Provider Business Practice Location Address
First Line : 8201 E RIVERSIDE BLVD
Second Line :
City : ROCKFORD
State : IL
Zip : 61114-2300
Country : US
Telephone Number : 815-971-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 08/05/2025

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