MEDICARE: BEVERLY C DAVIS M.D.

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	A31558	CA

General Provider Information

NPI Number	:	1821002874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY C DAVIS M.D.

Provider Business Mailing Address
First Line	:	3628 E IMPERIAL HWY
Second Line	:	SUITE 202
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3628 IMPERIAL HWY
Second Line	:	202
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2600
Country	:	US
Telephone Number	:	310-631-5000
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	09/18/2012

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