MEDICARE: DR. RENE DAVILA MD

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	31854	TN
2	207RG0100X	Gastroenterology Physician	31854	TN
3	207RG0100X	Gastroenterology Physician	20542	MS
4	207RI0008X	Hepatology Physician	31854	TN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831155308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENE DAVILA MD

Provider Business Mailing Address
First Line	:	P.O. BOX 24146
Second Line	:	UNIVERSITY PHYSICIANS, PLLC
City	:	JACKSON
State	:	MS
Zip	:	39225-4146
Country	:	US
Telephone Number	:	601-984-4540
Fax Number	:	601-984-4548

Provider Business Practice Location Address
First Line	:	2500 NORTH STATE STREET
Second Line	:	DEPT OF MEDICINE DIVISION OF DIGESTIVE DISEASE
City	:	JACKSON
State	:	MS
Zip	:	39216-4505
Country	:	US
Telephone Number	:	601-984-4540
Fax Number	:	601-984-4548

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	07/03/2012

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Directions to “ DR. RENE DAVILA MD” Practice Location

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