Provider Demographics
NPI:1285675413
Name:DAVIS, JEFF P (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:P
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12115 E 21ST ST N
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3567
Mailing Address - Country:US
Mailing Address - Phone:316-440-7000
Mailing Address - Fax:316-440-7006
Practice Address - Street 1:12115 E 21ST ST N
Practice Address - Street 2:SUITE 107
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3567
Practice Address - Country:US
Practice Address - Phone:316-440-7000
Practice Address - Fax:316-440-7006
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2014-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-30240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS455470OtherFIRSTGUARD
KS110718OtherBCBS
KS100643480DMedicaid
KS100416440AMedicaid
KS104714OtherCHAMPUS
KS104714OtherBCBS INDIVIDUAL
KSP00238093OtherRAILROAD MEDICARE INDIVID