Provider Demographics
NPI:1295225779
Name:DAVIS, CALVIN EUGENE (DPM)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:EUGENE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 TALBOT RD S STE 350
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5767
Mailing Address - Country:US
Mailing Address - Phone:425-690-3510
Mailing Address - Fax:425-690-9510
Practice Address - Street 1:4033 TALBOT RD S STE 350
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5767
Practice Address - Country:US
Practice Address - Phone:425-690-3510
Practice Address - Fax:425-690-9510
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN892213ES0103X
WAPO61504285213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ066424Medicaid