Healthcare Provider Details

I. General information

NPI: 1043302656
Provider Name (Legal Business Name): GORDON DOYLE DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON #100
PHOENIX AZ
85013
US

IV. Provider business mailing address

300 W CLARENDON #100
PHOENIX AZ
85013
US

V. Phone/Fax

Practice location:
  • Phone: 602-265-1112
  • Fax: 602-264-4101
Mailing address:
  • Phone: 602-265-1112
  • Fax: 602-264-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number12102
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: