Provider Demographics
NPI:1033192513
Name:DAVIS, MAYLI L (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYLI
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 COLLEYVILLE BOULEVARD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6228
Mailing Address - Country:US
Mailing Address - Phone:817-329-4480
Mailing Address - Fax:817-488-5993
Practice Address - Street 1:6208 COLLEYVILLE BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6228
Practice Address - Country:US
Practice Address - Phone:817-329-4480
Practice Address - Fax:817-488-5993
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5739174400000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3344906OtherBCBS BLUE LINK NUMBER
TX10022132Medicaid
TX4589684OtherAETNA
TX8A6670OtherBCBS INDIVIDUAL NUMBER
TX0067EZOtherBCBS GROUP NUMBER
TX127504201Medicaid
TX00550XMedicare ID - Type UnspecifiedGROUP NUMBER
TX180040008Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX3344906OtherBCBS BLUE LINK NUMBER
TX8A6670OtherBCBS INDIVIDUAL NUMBER