Healthcare Provider Details

I. General information

NPI: 1063999639
Provider Name (Legal Business Name): MATTHEW S DAVIS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 NE 134TH ST STE 203
VANCOUVER WA
98686-3028
US

IV. Provider business mailing address

944 NE HAZELFERN PL
PORTLAND OR
97232-2628
US

V. Phone/Fax

Practice location:
  • Phone: 971-770-1449
  • Fax:
Mailing address:
  • Phone: 626-318-5854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD60849018
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60849018
License Number StateWA

VIII. Authorized Official

Name: DR. MATTHEW S DAVIS
Title or Position: OWNER
Credential: MD
Phone: 626-318-5854