MEDICARE: DR. PAUL EUGENE DAVIS JR. 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036066287	IL

General Provider Information

NPI Number	:	1922253251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL EUGENE DAVIS JR. M.D.

Provider Business Mailing Address
First Line	:	10022 PACIFIC AVE
Second Line	:	P.O. BOX 190
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-1837
Country	:	US
Telephone Number	:	847-678-5130
Fax Number	:	847-678-5168

Provider Business Practice Location Address
First Line	:	10022 PACIFIC AVE
Second Line	:
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-1837
Country	:	US
Telephone Number	:	847-678-5130
Fax Number	:	847-678-5168

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

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	12/01/2008

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