Healthcare Provider Details

I. General information

NPI: 1467616326
Provider Name (Legal Business Name): BENJAMIN PHILLIP DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR C42-E11 GH
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR C42-E11 GH
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-2413
  • Fax:
Mailing address:
  • Phone: 319-356-4899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number42866
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35.121205
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: