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NPI Code Detail

MEDICARE: H GORDON DAVIS III MD SC

MEDICARE: H GORDON DAVIS III MD SC
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
1207V00000XObstetrics & Gynecology PhysicianIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
131602229OTHERILBCBS

General Provider Information

NPI Number : 1962488262
Entity Type Code : Organization
Provider Name (Legal Business Name) : H GORDON DAVIS III MD SC
Provider Business Mailing Address
First Line : 2500 W HIGGINS RD
Second Line : #640
City : HOFFMAN ESTATES
State : IL
Zip : 60195-5220
Country : US
Telephone Number : 847-884-0906
Fax Number : 847-884-0994
Provider Business Practice Location Address
First Line : 2500 W HIGGINS RD
Second Line : #640
City : HOFFMAN ESTATES
State : IL
Zip : 60195-5220
Country : US
Telephone Number : 847-884-0906
Fax Number : 847-884-0994
Authorized Official
Title or Position : OBSTETRICIAN GYNECOLOGIST
Name : DR. HENRY GORDON DAVIS III
Credential : MD
Telephone Number : 847-884-0906
Provider Enumeration Date : 12/19/2005
Last Update Date : 08/22/2020

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