Healthcare Provider Details

I. General information

NPI: 1205930294
Provider Name (Legal Business Name): FREDERICK BRYANT DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7319 LATONA AVE NE
SEATTLE WA
98115
US

IV. Provider business mailing address

7319 LATONA AVE NE
SEATTLE WA
98115
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-1898
  • Fax: 206-729-0564
Mailing address:
  • Phone: 206-525-1898
  • Fax: 206-729-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10139
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: