Healthcare Provider Details

I. General information

NPI: 1346216421
Provider Name (Legal Business Name): HENRY HORTON DAVIS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18269 COLONY DR UNIT 401
FAIRHOPE AL
36532-1148
US

IV. Provider business mailing address

PO BOX 850
PORT ANGELES WA
98362-0146
US

V. Phone/Fax

Practice location:
  • Phone: 251-421-1995
  • Fax: 251-625-1507
Mailing address:
  • Phone: 360-417-7111
  • Fax: 360-417-7342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number180693
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22834
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11870
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60640294
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: