Healthcare Provider Details

I. General information

NPI: 1467471284
Provider Name (Legal Business Name): STEVEN B DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

1308 E 900 S STE C
ST GEORGE UT
84790-8730
US

V. Phone/Fax

Practice location:
  • Phone: 435-688-4000
  • Fax:
Mailing address:
  • Phone: 435-673-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number291097-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number291097-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number291097-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number291097-1205
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number11176
License Number StateNV

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier107005811101
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerIHC
# 2
Identifier870487570004
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer
# 3
Identifier870487570DA2
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerEMIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: