Healthcare Provider Details

I. General information

NPI: 1720074081
Provider Name (Legal Business Name): JAMES R. DAVIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 HIDDEN MEADOW DR
MUSTANG OK
73064-9684
US

IV. Provider business mailing address

5525 HIDDEN MEADOW DR
MUSTANG OK
73064-9684
US

V. Phone/Fax

Practice location:
  • Phone: 405-376-5121
  • Fax:
Mailing address:
  • Phone: 405-376-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3657
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number3657
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: