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General NPI Number Information
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NPI Number | 1982048856
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Entity Type | Individual
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Provider Name | BETHANY DAVIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 2705 N 4TH ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-1846
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Country | US
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Telephone | 928-233-8801
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35662
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City | BELFAST
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State | ME
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Zip | 04915-0634
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Country | US
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Telephone |
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Fax | 928-447-7240
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 51839
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License Number State | AZ
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