Healthcare Provider Details

I. General information

NPI: 1386740462
Provider Name (Legal Business Name): VICTOR M DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ARROW ST
ST IGNATIUS MT
59865-0679
US

IV. Provider business mailing address

PO BOX 679
ST IGNATIUS MT
59865-0679
US

V. Phone/Fax

Practice location:
  • Phone: 406-745-4444
  • Fax: 406-745-4907
Mailing address:
  • Phone: 406-745-4444
  • Fax: 406-745-4907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6402
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: