Provider Demographics
NPI:1003149436
Name:FREDERICK B DAVIS MD PS
Entity Type:Organization
Organization Name:FREDERICK B DAVIS MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-525-1898
Mailing Address - Street 1:7319 LATONA AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5311
Mailing Address - Country:US
Mailing Address - Phone:206-525-1898
Mailing Address - Fax:206-729-0564
Practice Address - Street 1:7319 LATONA AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5311
Practice Address - Country:US
Practice Address - Phone:206-525-1898
Practice Address - Fax:206-729-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10139102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1204700Medicaid
WA1204700Medicaid
WA6000101188Medicare NSC