Provider Demographics
NPI:1053330712
Name:DAVIS, GEORGE E (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:705 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3053
Mailing Address - Country:US
Mailing Address - Phone:920-887-1151
Mailing Address - Fax:920-887-3353
Practice Address - Street 1:705 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3053
Practice Address - Country:US
Practice Address - Phone:920-887-1151
Practice Address - Fax:920-887-3353
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-05-16
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Provider Licenses
StateLicense IDTaxonomies
WI21978207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI180012216OtherRAIL ROAD MEDICARE
WI1003606OtherPHYSICIANS PLUS HMO
180012216OtherRAIL ROAD MEDICARE
WI7746OtherNETWORK HEALTH PLAN
WI934OtherDEAN CARE HMO
WI0101OtherJOHN DEERE HEALTH PLAN
WI30404100Medicaid
WI39115615602OtherUNITY HMO
WI39115615602OtherUNITY HMO
B52328Medicare UPIN