Healthcare Provider Details

I. General information

NPI: 1417043092
Provider Name (Legal Business Name): ST. LUKE'S HEALTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ROUTE 134 BUILDING #1
SOUTH DENNIS MA
02660
US

IV. Provider business mailing address

900 ROUTE 134 BUILDING #1
SOUTH DENNIS MA
02660
US

V. Phone/Fax

Practice location:
  • Phone: 508-385-0890
  • Fax:
Mailing address:
  • Phone: 508-385-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number213386
License Number StateMA

VIII. Authorized Official

Name: DR. JEFFREY PHILLIPS DAVIES
Title or Position: OWNER
Credential: D.O.
Phone: 508-385-0890