Provider Demographics
NPI:1083669170
Name:DAVIS, ALEXANDER ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:ALLEN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:220 STANDIFORD AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1159
Mailing Address - Country:US
Mailing Address - Phone:209-606-5567
Mailing Address - Fax:209-579-5637
Practice Address - Street 1:1401 SPANOS CT
Practice Address - Street 2:SUITE 101
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2810
Practice Address - Country:US
Practice Address - Phone:209-606-5567
Practice Address - Fax:209-525-3891
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2021-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG67830207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG67830OtherMEDICAL LICENSE
F16267Medicare UPIN
00G678300Medicare ID - Type Unspecified