Healthcare Provider Details

I. General information

NPI: 1639115892
Provider Name (Legal Business Name): HARRY QUIGG DAVIS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIAGN ARMY MEDICAL CENTER MCHJ-FP (AVN MED)
TACOMA WA
98431-0001
US

IV. Provider business mailing address

1825 LAKEHURST DR SE
OLYMPIA WA
98501-4268
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4600
  • Fax: 253-968-2608
Mailing address:
  • Phone: 253-968-4600
  • Fax: 253-968-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number22440
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: