Provider Demographics
NPI:1437193414
Name:DAVIS, JAY TOMES (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:TOMES
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 PARK STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:62101-1780
Mailing Address - Country:US
Mailing Address - Phone:270-843-5133
Mailing Address - Fax:270-843-5134
Practice Address - Street 1:546 PARK STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1780
Practice Address - Country:US
Practice Address - Phone:270-843-5133
Practice Address - Fax:270-843-5134
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25834207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64258346Medicaid
KY000000062935OtherANTHEM BLUE SHIELD
KY1597801Medicare ID - Type Unspecified
KYP400041176Medicare PIN
KYD95924Medicare UPIN