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General NPI Number Information
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NPI Number | 1962601005
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Entity Type | Individual
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Provider Name | THOMAS WAYNE DAVIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 2129 SW 59TH ST SUITE 1238
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City | OKLAHOMA CITY
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State | OK
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Zip | 73119-7024
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Country | US
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Telephone | 405-713-5779
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Fax | 404-681-8085
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Provider Business Mailing Address
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Address Line | 2129 SW 59TH ST SUITE 1238
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City | OKLAHOMA CITY
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State | OK
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Zip | 73119-7024
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Country | US
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Telephone | 405-713-5779
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Fax | 404-681-8085
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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 | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 10683
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208U00000X
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Taxonomy Name | Clinical Pharmacology Physician
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License Number | 10683
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License Number State | OK
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