MEDICARE: DR. RONALD T. 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
1	174400000X	Specialist	G21783	CA
2	2085R0001X	Radiation Oncology Physician	G21783	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G21783	OTHER	CA	CALIFORNIA LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184622532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD T. DAVIS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 33865
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92163-3865
Country	:	US
Telephone Number	:	619-220-4100
Fax Number	:	619-270-3423

Provider Business Practice Location Address
First Line	:	2466 1ST AVE
Second Line	:	STE B
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-1408
Country	:	US
Telephone Number	:	619-230-0400
Fax Number	:	619-325-3688

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	03/07/2023

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