Healthcare Provider Details

I. General information

NPI: 1215096649
Provider Name (Legal Business Name): JAY BURTON DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S SHEPHERD DR
HOUSTON TX
77098-5316
US

IV. Provider business mailing address

4100 S SHEPHERD DR
HOUSTON TX
77098-5316
US

V. Phone/Fax

Practice location:
  • Phone: 713-524-9800
  • Fax: 713-524-1115
Mailing address:
  • Phone: 713-524-9800
  • Fax: 713-524-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK0707
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: