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General NPI Number Information
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NPI Number | 1568666121
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Entity Type | Individual
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Provider Name | JUSTIN MARK DAVIS MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 5501 N PORTLAND AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-2074
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Country | US
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Telephone | 405-604-6000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 248875 SUITE 300
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City | OKLAHOMA CITY
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State | OK
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Zip | 73124-8875
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Country | US
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Telephone | 918-392-2944
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Fax | 918-664-2521
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | BP1-0026250
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 27437
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License Number State | OK
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