Provider Demographics
NPI:1326143769
Name:DAVIS, WILLIAM MCLOUGHRY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MCLOUGHRY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 MEDICAL PKWY
Mailing Address - Street 2:SUITE 510
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1019
Mailing Address - Country:US
Mailing Address - Phone:512-454-6723
Mailing Address - Fax:512-459-4412
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:SUITE 510
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1019
Practice Address - Country:US
Practice Address - Phone:512-454-6723
Practice Address - Fax:512-459-4412
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5957208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD48190Medicare UPIN
TXJP32Medicare ID - Type Unspecified