Provider Demographics
NPI:1326009366
Name:LEON N DAVIS MD PC
Entity Type:Organization
Organization Name:LEON N DAVIS MD PC
Other - Org Name:EXTENDED ARM PHYSICIANS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:NOLAN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:334-262-2071
Mailing Address - Street 1:PO BOX 230577
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-0577
Mailing Address - Country:US
Mailing Address - Phone:334-262-2071
Mailing Address - Fax:334-262-2832
Practice Address - Street 1:1725 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-262-2071
Practice Address - Fax:334-269-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000022924Medicaid
AL051022924OtherBCBS OF AL
F32977Medicare UPIN
AL000022924Medicaid