Healthcare Provider Details

I. General information

NPI: 1871917666
Provider Name (Legal Business Name): DAVIS GROUP, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 W LAKE MEAD BLVD 104
LAS VEGAS NV
89128-7648
US

IV. Provider business mailing address

8440 W LAKE MEAD BLVD 104
LAS VEGAS NV
89128-7648
US

V. Phone/Fax

Practice location:
  • Phone: 702-489-4838
  • Fax: 702-489-4837
Mailing address:
  • Phone: 702-489-4838
  • Fax: 702-489-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number10713
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number10713
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number10713
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14027
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number14027
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number10713
License Number StateNV
# 7
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number10713
License Number StateNV
# 8
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10713
License Number StateNV
# 9
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number10713
License Number StateNV

VIII. Authorized Official

Name: CRAIG DAVIS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 702-489-4838