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General NPI Number Information
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NPI Number | 1396010096
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Entity Type | Organization
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Legal Business Name | SAMUEL H. DAVIS MD PA
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 604 E. BAILEY BOSWELL SUITE 140
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City | SAGINAW
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State | TX
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Zip | 76131
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Country | US
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Telephone | 817-484-6610
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Fax | 817-423-7476
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Provider Business Mailing Address
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Address Line | 3205 MEDPARK DRIVE
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City | DENTON
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State | TX
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Zip | 76208-6932
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Country | US
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Telephone | 940-484-6500
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Fax | 800-481-0150
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Authorized Official
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Title or Position | CEO/SENIOR PARTNER-ON-SITE-MEDICAL
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Name | MR. DEAN A. DELAWTER
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Credential | MHA
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Telephone | 940-484-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | M7134
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License Number State | TX
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