Healthcare Provider Details

I. General information

NPI: 1871819797
Provider Name (Legal Business Name): TROY A DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MISSOURI AVE PATHOLOGY DEPT
JEFFERSONVILLE IN
47130-3725
US

IV. Provider business mailing address

1941 BISHOP LN STE 1018
LOUISVILLE KY
40218-1928
US

V. Phone/Fax

Practice location:
  • Phone: 502-456-6212
  • Fax: 502-456-4440
Mailing address:
  • Phone: 502-456-6211
  • Fax: 502-456-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01076475A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number01076475A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: