Provider Demographics
NPI:1063498566
Name:DAVIS, WILLIAM EUGENE JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EUGENE
Last Name:DAVIS
Suffix:JR
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 1:4200 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5945
Mailing Address - Country:US
Mailing Address - Phone:515-401-1950
Mailing Address - Fax:515-401-1955
Practice Address - Street 1:4200 UNIVERSITY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5945
Practice Address - Country:US
Practice Address - Phone:515-401-1950
Practice Address - Fax:515-401-1955
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31229207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06009OtherTRICARE PROVIDER #
IA050045048OtherRAILROAD MEDICARE NUMBER
IAIA0168OtherJOHN DEERE PROVIDER #
IA54810OtherBLUE SHIELD PROVIDER #
IA0141622Medicaid
IA5677OtherMIDLANDS PROVIDER #
IA5677OtherMIDLANDS PROVIDER #