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NPI Code Detail

MEDICARE: DR. WILLIE BOB DAVIS ME

MEDICARE: DR. WILLIE BOB DAVIS ME
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
1207Q00000XFamily Medicine PhysicianKS 04-17213KS
2207Q00000XFamily Medicine PhysicianMO R5059MO
32085R0202XDiagnostic Radiology PhysicianR5059MO
4208D00000XGeneral Practice Physician04-17213KS
52085R0202XDiagnostic Radiology Physician04-17213KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659376952
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIE BOB DAVIS ME
Provider Business Mailing Address
First Line : 5800 FOXRIDGE DR
Second Line : STE 240
City : MISSION
State : KS
Zip : 66202-2338
Country : US
Telephone Number : 913-261-3153
Fax Number : 913-262-3295
Provider Business Practice Location Address
First Line : 20333 W 151ST ST
Second Line :
City : OLATHE
State : KS
Zip : 66061-5350
Country : US
Telephone Number : 913-791-4408
Fax Number : 913-791-4438
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 04/19/2022

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