Healthcare Provider Details

I. General information

NPI: 1538123534
Provider Name (Legal Business Name): PAUL MICHAEL DAVIS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD SUITE 1008
BATON ROUGE LA
70808-4300
US

IV. Provider business mailing address

1200 LAWRENCE PKWY
SAINT GABRIEL LA
70776-5119
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-0416
  • Fax: 225-769-9212
Mailing address:
  • Phone: 225-642-6989
  • Fax: 225-642-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number27948
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number1256R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: