Healthcare Provider Details

I. General information

NPI: 1134496185
Provider Name (Legal Business Name): WILLIAM DAVIS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 GREENFIELD DR
EL CAJON CA
92021-3520
US

IV. Provider business mailing address

1663 GREENFIELD DR
EL CAJON CA
92021-3520
US

V. Phone/Fax

Practice location:
  • Phone: 619-401-7913
  • Fax: 619-401-7916
Mailing address:
  • Phone: 619-401-7913
  • Fax: 619-401-7916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberR052467
License Number StateCA

VIII. Authorized Official

Name: FRED E SUFFICOOL
Title or Position: MANAGER
Credential:
Phone: 619-401-7913