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General NPI Number Information
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NPI Number | 1861616153
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Entity Type | Individual
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Provider Name | LUIS R DAVILA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 3400 HIGHWAY 78 E MEDICAL ARTS TOWER SUITE 504
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City | JASPER
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State | AL
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Zip | 35501-8907
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Country | US
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Telephone | 205-295-9630
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Fax | 205-295-9362
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Provider Business Mailing Address
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Address Line | PO BOX 391
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City | JASPER
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State | AL
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Zip | 35502-0391
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Country | US
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Telephone | 205-295-9630
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Fax | 205-295-9632
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 25227
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License Number State | AL
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