Provider Demographics
NPI:1124024880
Name:DAVIS, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5120 MASTHEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4366
Mailing Address - Country:US
Mailing Address - Phone:505-243-7546
Mailing Address - Fax:505-243-7547
Practice Address - Street 1:5120 MASTHEAD ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4366
Practice Address - Country:US
Practice Address - Phone:505-243-7546
Practice Address - Fax:505-243-7547
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2023-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM2000-174207N00000X, 207ND0101X
IA32332207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC539595Medicare UPIN