Provider Demographics
NPI:1407963499
Name:DAVIS, JR, MERRITT G (DO)
Entity Type:Individual
Prefix:DR
First Name:MERRITT
Middle Name:G
Last Name:DAVIS, JR
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:7703 FLOYD CURL DRIVE, MC 7798
Mailing Address - Street 2:UTHSCSA, DEPT. OF REHAB MEDICINE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-358-4328
Mailing Address - Fax:210-358-4806
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:HYPERBARICS DEPARTMENT
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-4320
Practice Address - Fax:210-358-4806
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ4766207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116151505Medicaid
TX8A4721OtherBLUE CROSS BLUE SHIELD
TX116151505Medicaid
TX8522J5Medicare PIN