MEDICARE: DR. GARRY TODD DAVIS D.O.

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	207Q00000X	Family Medicine Physician	L6344	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00364190	OTHER	TX	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1699748434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRY TODD DAVIS D.O.

Provider Business Mailing Address
First Line	:	PO BOX 128
Second Line	:
City	:	COMANCHE
State	:	TX
Zip	:	76442-0128
Country	:	US
Telephone Number	:	254-879-4910
Fax Number	:	254-879-4991

Provider Business Practice Location Address
First Line	:	10201 HIGHWAY 16
Second Line	:
City	:	COMANCHE
State	:	TX
Zip	:	76442-4462
Country	:	US
Telephone Number	:	254-879-4910
Fax Number	:	254-879-4991

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	06/28/2008

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