Provider Demographics
NPI:1083828404
Name:CHESTER R DAVIS MD PA
Entity Type:Organization
Organization Name:CHESTER R DAVIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT SECRETARY TREAS
Authorized Official - Prefix:MR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-232-7324
Mailing Address - Street 1:1125 SW GAGE BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-2280
Mailing Address - Country:US
Mailing Address - Phone:785-232-7324
Mailing Address - Fax:785-354-7155
Practice Address - Street 1:1125 SW GAGE BLVD
Practice Address - Street 2:STE C
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2280
Practice Address - Country:US
Practice Address - Phone:785-232-7324
Practice Address - Fax:785-354-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04 16732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B69298Medicare UPIN
KS054665DAMedicare ID - Type Unspecified