Provider Demographics
NPI:1003899816
Name:DAVIS, DONN MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:DONN
Middle Name:MARSHALL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 810221
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75381-0221
Mailing Address - Country:US
Mailing Address - Phone:520-519-7700
Mailing Address - Fax:
Practice Address - Street 1:1100 GAIL GARDNER WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1690
Practice Address - Country:US
Practice Address - Phone:928-776-1040
Practice Address - Fax:928-776-1041
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39768174400000X
COG531972085R0001X
AZ589932085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75206307Medicaid
CO920007066OtherRR MEDICARE
CAE71885Medicare UPIN
CO75206307Medicaid