Provider Demographics
NPI:1265663017
Name:DAVIS, WAYNE EARL (DO)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:EARL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 AMRON CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-1918
Mailing Address - Country:US
Mailing Address - Phone:573-874-1616
Mailing Address - Fax:573-875-0300
Practice Address - Street 1:3600 AMRON CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-1918
Practice Address - Country:US
Practice Address - Phone:573-874-1616
Practice Address - Fax:573-875-0300
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015006386207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist