MEDICARE: DR. MUSTAFA KAMARI 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	208600000X	Surgery Physician	48413	AZ
2	208600000X	Surgery Physician	68138	GA

General Provider Information

NPI Number	:	1891967444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUSTAFA KAMARI DAVIS M.D.

Provider Business Mailing Address
First Line	:	3269 N STOCKTON HILL RD
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409-3619
Country	:	US
Telephone Number	:	928-263-4722
Fax Number	:	928-263-4794

Provider Business Practice Location Address
First Line	:	3104 N STOCKTON HILL RD
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-4183
Country	:	US
Telephone Number	:	928-681-8720
Fax Number	:

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

Provider Enumeration Date	:	03/24/2008
Last Update Date	:	09/11/2024

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