Healthcare Provider Details

I. General information

NPI: 1972960862
Provider Name (Legal Business Name): DERON EARL DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARL R. DARNALL ARMY MEDICAL CENTER, 36065 SANTE FE AVE
FT HOOD TX
76544
US

IV. Provider business mailing address

565 BIBB LN
BRENT AL
35034-4040
US

V. Phone/Fax

Practice location:
  • Phone: 254-553-2053
  • Fax:
Mailing address:
  • Phone: 205-926-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101262033
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number54149
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: