Healthcare Provider Details

I. General information

NPI: 1710942115
Provider Name (Legal Business Name): DARWIN L DAVIS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 KANELL BLVD SUITE 103
POPLAR BLUFF MO
63901-4045
US

IV. Provider business mailing address

PO BOX 989
POPLAR BLUFF MO
63902-0989
US

V. Phone/Fax

Practice location:
  • Phone: 573-727-9130
  • Fax: 573-727-9128
Mailing address:
  • Phone: 573-778-0020
  • Fax: 573-776-7548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number100921
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: