MEDICARE: DR. GREGORY J DAVIS DO

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	207R00000X	Internal Medicine Physician	34007492D	OH
2	207R00000X	Internal Medicine Physician	34007492	OH

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	:	1609862291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY J DAVIS DO

Provider Business Mailing Address
First Line	:	11201 SHAKER BLVD
Second Line	:	SUITE 240
City	:	CLEVELAND
State	:	OH
Zip	:	44104-3873
Country	:	US
Telephone Number	:	216-791-0017
Fax Number	:	216-791-0021

Provider Business Practice Location Address
First Line	:	11201 SHAKER BLVD
Second Line	:	SUITE 240
City	:	CLEVELAND
State	:	OH
Zip	:	44104-3873
Country	:	US
Telephone Number	:	440-842-5555
Fax Number	:	440-842-5556

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	11/27/2012

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