Provider Demographics
NPI:1346216421
Name:DAVIS, HENRY HORTON III (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:HORTON
Last Name:DAVIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-417-7111
Mailing Address - Fax:360-417-7342
Practice Address - Street 1:18269 COLONY DR UNIT 401
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1148
Practice Address - Country:US
Practice Address - Phone:251-421-1995
Practice Address - Fax:251-625-1507
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR180693207Q00000X
HI22834207Q00000X
AL11870207Q00000X
WA60640294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C72154Medicare UPIN
000018805Medicare ID - Type Unspecified