MEDICARE: RICHARD T. DAVIS, MD PC

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	207X00000X	Orthopaedic Surgery Physician	MD28858	OR

General Provider Information

NPI Number	:	1538306725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD T. DAVIS, MD PC

Provider Business Mailing Address
First Line	:	1050 SW 3RD AVE
Second Line	:	SUITE 1200
City	:	ONTARIO
State	:	OR
Zip	:	97914-2193
Country	:	US
Telephone Number	:	541-889-3111
Fax Number	:	541-889-3999

Provider Business Practice Location Address
First Line	:	1050 SW 3RD AVE
Second Line	:	SUITE 1200
City	:	ONTARIO
State	:	OR
Zip	:	97914-2193
Country	:	US
Telephone Number	:	541-889-3111
Fax Number	:	541-889-3999

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. RICHARD T DAVIS
Credential	:	MD
Telephone Number	:	541-889-3111

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/09/2009

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