Provider Demographics
NPI:1295019016
Name:DAVIS, BRIAN A (LMT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 ELDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-2811
Mailing Address - Country:US
Mailing Address - Phone:281-467-1547
Mailing Address - Fax:
Practice Address - Street 1:2222 SETTLERS WAY BLVD
Practice Address - Street 2:APT 1415
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5262
Practice Address - Country:US
Practice Address - Phone:281-467-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102825OtherTDSHS