Healthcare Provider Details

I. General information

NPI: 1306039706
Provider Name (Legal Business Name): ALEXANDER A DAVIS, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SPANOS COURT SUITE 101
MODESTO CA
95355-2812
US

IV. Provider business mailing address

220 STANDIFORD AVE SUITE F
MODESTO CA
95350-1159
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-3888
  • Fax: 209-579-5637
Mailing address:
  • Phone: 209-525-3888
  • Fax: 209-579-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberG67830
License Number StateCA

VIII. Authorized Official

Name: MR. ALEXANDER DAVIS
Title or Position: OWNER/MD
Credential: MD
Phone: 209-525-3888