Provider Demographics
NPI:1437399987
Name:DAVIS, JEREMY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:LEE
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 1:10 CENTER DRIVE, MSC 1201
Mailing Address - Street 2:ROOM 4-3760
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892
Mailing Address - Country:US
Mailing Address - Phone:301-496-2127
Mailing Address - Fax:301-451-6933
Practice Address - Street 1:545 BARNHILL DR
Practice Address - Street 2:EH 202
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5112
Practice Address - Country:US
Practice Address - Phone:317-274-4966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2681832086X0206X
IN01063880A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology