Healthcare Provider Details

I. General information

NPI: 1871591354
Provider Name (Legal Business Name): DAVID GARLAND DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11623 ANGUS RD SUITE 15
AUSTIN TX
78759-4003
US

IV. Provider business mailing address

11623 ANGUS RD SUITE 15
AUSTIN TX
78759-4003
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-7170
  • Fax:
Mailing address:
  • Phone: 512-346-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberTX E-0875
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberTX E-0875
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberTX E-0875
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberTX E-0875
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: