MEDICARE: CARL RICHARD DAVIS MD

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	207P00000X	Emergency Medicine Physician	2006023528	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2006023528	OTHER	MO	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1629186770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL RICHARD DAVIS MD

Provider Business Mailing Address
First Line	:	1102 NE PARVIN ROAD
Second Line	:	#302
City	:	KANSAS CITY
State	:	MO
Zip	:	64116
Country	:	US
Telephone Number	:	816-560-3322
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 NE PARVIN ROAD
Second Line	:	#302
City	:	KANSAS CITY
State	:	MO
Zip	:	64116
Country	:	US
Telephone Number	:	816-560-3322
Fax Number	:

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	07/08/2007

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Directions to “ CARL RICHARD DAVIS MD” Practice Location

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