Healthcare Provider Details

I. General information

NPI: 1528696499
Provider Name (Legal Business Name): JEFFREY DEAN DAVIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 KINGSBOROUGH SQ STE 300
CHESAPEAKE VA
23320-5055
US

IV. Provider business mailing address

612 KINGSBOROUGH SQ STE 300
CHESAPEAKE VA
23320-5055
US

V. Phone/Fax

Practice location:
  • Phone: 757-609-3380
  • Fax:
Mailing address:
  • Phone: 757-609-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0102210447
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2023-03167
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: