Healthcare Provider Details

I. General information

NPI: 1942396429
Provider Name (Legal Business Name): RICHARD H. DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 COLLEGE AVE SUITE E
MODESTO CA
95350-4057
US

IV. Provider business mailing address

1429 COLLEGE AVE SUITE E
MODESTO CA
95350-4057
US

V. Phone/Fax

Practice location:
  • Phone: 209-578-1582
  • Fax: 209-578-5185
Mailing address:
  • Phone: 209-578-1582
  • Fax: 209-578-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberAD1415923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: