MEDICARE: DR. WILLIAM L. DAVIS JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	213531	NY
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	25MA07797000	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	200037035	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	361012	OTHER	NY	MVP (MONROE)
2	5956750	OTHER	NY	AETNA PPO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2695H1	OTHER	NY	EMPIRE BCBS (STONY POINT)
5	2695H3	OTHER	NY	EMPIRE BCBS (AIRMONT)
6	5902684	OTHER	NY	GHI PPO
7	132721370	OTHER	NY	TAX ID#
8	0D1365	OTHER	NY	HEALTHNET
10	2695H2	OTHER	NY	EMPIRE BCBS (MONROE)
11	2176547	OTHER	NY	AETNA HMO
12	361012	OTHER	NY	MVP (AIRMONT/STONY POINT)
13	P1310314	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1063416501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM L. DAVIS JR. MD

Provider Business Mailing Address
First Line	:	507 AIRPORT EXECUTIVE PARK
Second Line	:
City	:	NANUET
State	:	NY
Zip	:	10954-5238
Country	:	US
Telephone Number	:	845-262-5313
Fax Number	:	845-262-5330

Provider Business Practice Location Address
First Line	:	327 ROUTE 59
Second Line	:
City	:	AIRMONT
State	:	NY
Zip	:	10952
Country	:	US
Telephone Number	:	845-356-2900
Fax Number	:	845-356-7797

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	02/29/2016

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