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NPI Code Detail

MEDICARE: DR. CHARLES REESE DAVIS M.D.

MEDICARE: DR. CHARLES REESE 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
1208600000XSurgery Physician241883NY
2208600000XSurgery Physician6463025-1205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326136565
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES REESE DAVIS M.D.
Provider Business Mailing Address
First Line : PO BOX 70629
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84170-0629
Country : US
Telephone Number : 801-965-3600
Fax Number :
Provider Business Practice Location Address
First Line : 4252 S HIGHLAND DR STE 200
Second Line :
City : HOLLADAY
State : UT
Zip : 84124-2690
Country : US
Telephone Number : 801-965-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 09/25/2023

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