Provider Demographics
NPI:1164452421
Name:DAVIS, JOHN K III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:DAVIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-789-2663
Mailing Address - Fax:303-788-4871
Practice Address - Street 1:799 E HAMPDEN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2700
Practice Address - Country:US
Practice Address - Phone:303-789-2663
Practice Address - Fax:303-788-4871
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
174400000X
CO19810207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200972710AMedicaid
CO01198100Medicaid
WY129802000Medicaid
NE1245556091Medicaid
COCD6438Medicare PIN
COP01141076Medicare PIN
CO01198100Medicaid