MEDICARE: DR. PHILIP DAVIS PSYD

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	103TC0700X	Clinical Psychologist	1496	OK

General Provider Information

NPI Number	:	1144678137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP DAVIS PSYD

Provider Business Mailing Address
First Line	:	9905 S PENNSYLVANIA AVE STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6920
Country	:	US
Telephone Number	:	405-358-3706
Fax Number	:

Provider Business Practice Location Address
First Line	:	3037 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3637
Country	:	US
Telephone Number	:	405-358-3706
Fax Number	:

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

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	12/16/2025

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