Provider Demographics
NPI:1306830294
Name:DAVY, TREVOR A (DPM)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:A
Last Name:DAVY
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 1:6024 HOOVER RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8133
Mailing Address - Country:US
Mailing Address - Phone:614-539-4964
Mailing Address - Fax:614-539-4609
Practice Address - Street 1:6024 HOOVER RD
Practice Address - Street 2:SUITE F
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8133
Practice Address - Country:US
Practice Address - Phone:617-539-4934
Practice Address - Fax:614-539-4609
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003396213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2546865Medicaid
OHDA4154121Medicare ID - Type Unspecified
OH2546865Medicaid