Healthcare Provider Details

I. General information

NPI: 1093389157
Provider Name (Legal Business Name): DAVIS FREDERICK PHILLIPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 N ROXBORO ST
DURHAM NC
27704-2702
US

IV. Provider business mailing address

3643 N ROXBORO ST
DURHAM NC
27704-2702
US

V. Phone/Fax

Practice location:
  • Phone: 919-470-8490
  • Fax: 919-470-8469
Mailing address:
  • Phone: 919-470-8490
  • Fax: 919-470-8469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2024-01271
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: