MEDICARE: RONALD LEE DAVIS III MD

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	208800000X	Urology Physician	31268	NC

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	:	1528054673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD LEE DAVIS III MD

Provider Business Mailing Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-1332
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 CHARLOIS BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1522
Country	:	US
Telephone Number	:	336-716-4131
Fax Number	:	336-713-0328

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	10/15/2021

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