MEDICARE: MR. KEITH L DAVIS 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	207Q00000X	Family Medicine Physician	35052285	OH

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

General Provider Information

NPI Number	:	1952488215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH L DAVIS MD

Provider Business Mailing Address
First Line	:	600 W. THIRD STREET
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-2633
Country	:	US
Telephone Number	:	419-522-6191
Fax Number	:	419-526-7939

Provider Business Practice Location Address
First Line	:	600 W 3RD ST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-2633
Country	:	US
Telephone Number	:	141-952-2619
Fax Number	:	419-525-6723

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/14/2021

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Directions to “ MR. KEITH L DAVIS MD” Practice Location

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