Provider Demographics
NPI:1033152814
Name:O. ROBERT DAVIS, MD, PA
Entity Type:Organization
Organization Name:O. ROBERT DAVIS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:O
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-488-8926
Mailing Address - Street 1:17480 DALLAS PKWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7337
Mailing Address - Country:US
Mailing Address - Phone:972-422-5941
Mailing Address - Fax:972-881-4390
Practice Address - Street 1:17480 DALLAS PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7337
Practice Address - Country:US
Practice Address - Phone:972-488-8926
Practice Address - Fax:972-881-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00809UMedicare PIN
TX00808UMedicare PIN