Provider Demographics
NPI:1376741843
Name:ROBERT W DAVIS MD PC
Entity Type:Organization
Organization Name:ROBERT W DAVIS MD PC
Other - Org Name:DAVIS PSYCHIATRIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-398-4300
Mailing Address - Street 1:229 BELLEMEADE BLVD
Mailing Address - Street 2:STE 404
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7153
Mailing Address - Country:US
Mailing Address - Phone:504-398-4300
Mailing Address - Fax:504-392-6803
Practice Address - Street 1:229 BELLEMEADE BLVD
Practice Address - Street 2:STE 404
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7153
Practice Address - Country:US
Practice Address - Phone:504-398-4300
Practice Address - Fax:504-392-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA805103TB0200X
LA16381041C0700X
LA8654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1940003Medicaid
LA51648Medicare PIN