Provider Demographics
NPI:1124232871
Name:DAVIS, SCOTT MURRAY (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MURRAY
Last Name:DAVIS
Suffix:
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 1:141 PIERCE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5326
Mailing Address - Country:US
Mailing Address - Phone:847-702-9746
Mailing Address - Fax:847-433-8581
Practice Address - Street 1:141 PIERCE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5326
Practice Address - Country:US
Practice Address - Phone:847-702-9746
Practice Address - Fax:847-433-8581
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD94004Medicare UPIN