MEDICARE: LARRY 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
1	207RN0300X	Nephrology Physician	F3888	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110206520	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1386628998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY R. DAVIS M.D.

Provider Business Mailing Address
First Line	:	7142 SAN PEDRO AVE
Second Line	:	SUITE 120
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-6256
Country	:	US
Telephone Number	:	210-661-5622
Fax Number	:	210-798-6811

Provider Business Practice Location Address
First Line	:	4330 MEDICAL DR STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3342
Country	:	US
Telephone Number	:	210-692-7228
Fax Number	:	210-692-9671

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	08/26/2020

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Directions to “ LARRY R. DAVIS M.D.” Practice Location

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