Healthcare Provider Details

I. General information

NPI: 1750306999
Provider Name (Legal Business Name): ROBERT W DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 LEGION AVE
HOUMA LA
70364-3339
US

IV. Provider business mailing address

521 LEGION AVE
HOUMA LA
70364-3339
US

V. Phone/Fax

Practice location:
  • Phone: 985-857-3612
  • Fax: 985-857-3782
Mailing address:
  • Phone: 985-857-3612
  • Fax: 985-857-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number016599
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: