Healthcare Provider Details

I. General information

NPI: 1952541088
Provider Name (Legal Business Name): RANDY JOHN DAVIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 N STEMMONS FWY STE S-105
DALLAS TX
75247-3836
US

IV. Provider business mailing address

8585 N STEMMONS FWY STE S-105
DALLAS TX
75247-3836
US

V. Phone/Fax

Practice location:
  • Phone: 469-502-4772
  • Fax: 214-459-3709
Mailing address:
  • Phone: 469-502-4772
  • Fax: 214-459-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberN2053
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN2053
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: