Healthcare Provider Details

I. General information

NPI: 1679558589
Provider Name (Legal Business Name): JEFFREY D DAVIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 55 SIGLER AVE.
MEMPHIS MO
63555-9726
US

IV. Provider business mailing address

314 E MCPHERSON ST
KIRKSVILLE MO
63501-3557
US

V. Phone/Fax

Practice location:
  • Phone: 660-465-7037
  • Fax: 660-465-7350
Mailing address:
  • Phone: 660-627-5757
  • Fax: 660-627-5802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2001023603
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: