Provider Demographics
NPI:1336145689
Name:DAVIS, WILLIAM BOYCE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BOYCE
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 1:107 MAIN ST
Mailing Address - Street 2:PO BOX 881
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-1930
Mailing Address - Country:US
Mailing Address - Phone:530-795-1110
Mailing Address - Fax:530-795-1115
Practice Address - Street 1:107 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694-1930
Practice Address - Country:US
Practice Address - Phone:530-795-1110
Practice Address - Fax:530-795-1115
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG54959OtherSTATE MEDICAL LICENSE
CA00G549590Medicaid
CA00G549590Medicaid
AD2788187OtherDEA NUMBER
CAG54959OtherSTATE MEDICAL LICENSE