Provider Demographics
NPI:1306039706
Name:ALEXANDER A DAVIS, MD INC
Entity Type:Organization
Organization Name:ALEXANDER A DAVIS, MD INC
Other - Org Name:MODESTO SPINE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-525-3888
Mailing Address - Street 1:220 STANDIFORD AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1159
Mailing Address - Country:US
Mailing Address - Phone:209-525-3888
Mailing Address - Fax:209-579-5637
Practice Address - Street 1:1401 SPANOS COURT
Practice Address - Street 2:SUITE 101
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2812
Practice Address - Country:US
Practice Address - Phone:209-525-3888
Practice Address - Fax:209-579-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67830261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G678300Medicare PIN
CAF16267Medicare UPIN