Healthcare Provider Details

I. General information

NPI: 1003899816
Provider Name (Legal Business Name): DONN MARSHALL DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GAIL GARDNER WAY
PRESCOTT AZ
86305-1690
US

IV. Provider business mailing address

PO BOX 810221
DALLAS TX
75381-0221
US

V. Phone/Fax

Practice location:
  • Phone: 928-776-1040
  • Fax: 928-776-1041
Mailing address:
  • Phone: 520-519-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number39768
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG53197
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number58993
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: