=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669665592
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM DAVIS MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2007
-----------------------------------------------------
Last Update Date | 07/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7877 PARKWAY DRIVE SUITE 1B
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91942-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-461-3717
-----------------------------------------------------
Fax | 619-461-5941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7877 PARKWAY DRIVE SUITE 1B
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91942-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-461-3717
-----------------------------------------------------
Fax | 619-461-5941
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WILLIAM B DAVIS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 619-461-3717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 247100000X
-----------------------------------------------------
Taxonomy Name | Radiologic Technologist
-----------------------------------------------------
License Number | R052467
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------