Healthcare Provider Details

I. General information

NPI: 1194773622
Provider Name (Legal Business Name): CYNTHIA L DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BYRON BLVD
CHAMBERLAIN SD
57325
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-234-6551
  • Fax: 605-234-7260
Mailing address:
  • Phone: 605-234-6551
  • Fax: 605-234-7260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4586
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: