Provider Demographics
NPI:1134496185
Name:WILLIAM DAVIS MD INC
Entity Type:Organization
Organization Name:WILLIAM DAVIS MD INC
Other - Org Name:MOBILE PHYSICIAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:SUFFICOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-401-7913
Mailing Address - Street 1:1663 GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-3520
Mailing Address - Country:US
Mailing Address - Phone:619-401-7913
Mailing Address - Fax:619-401-7916
Practice Address - Street 1:1663 GREENFIELD DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-3520
Practice Address - Country:US
Practice Address - Phone:619-401-7913
Practice Address - Fax:619-401-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR052467247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR052467Medicare PIN