Healthcare Provider Details

I. General information

NPI: 1821037334
Provider Name (Legal Business Name): RAY S DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

1 CHILDRENS PL C B 8116
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2694
  • Fax: 314-454-2515
Mailing address:
  • Phone: 314-454-2694
  • Fax: 314-454-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberR9698
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: