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NPI Code Detail

MEDICARE: DR. DIRK R. DAVIS M.D.

MEDICARE: DR. DIRK R. DAVIS M.D.
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
1207RG0100XGastroenterology Physician178601-1205UT

General Provider Information

NPI Number : 1134187263
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIRK R. DAVIS M.D.
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 435-752-1693
Fax Number : 435-792-1692
Provider Business Practice Location Address
First Line : 1350 N 500 E
Second Line :
City : LOGAN
State : UT
Zip : 84341-2400
Country : US
Telephone Number : 435-752-1693
Fax Number : 435-792-1692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2006
Last Update Date : 12/15/2016

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