Healthcare Provider Details

I. General information

NPI: 1952808966
Provider Name (Legal Business Name): IAN CHARLES DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4252 ARENDELL ST
MOREHEAD CITY NC
28557-2866
US

IV. Provider business mailing address

PO BOX 68
POLLOCKSVILLE NC
28573-0068
US

V. Phone/Fax

Practice location:
  • Phone: 252-808-0145
  • Fax: 252-808-2770
Mailing address:
  • Phone: 252-276-7706
  • Fax: 252-224-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2026-03898
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0100656
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: