Provider Demographics
NPI:1467421602
Name:DAVIS, BEN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:DAVID
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 1:3131 LA CANADA ST STE 217
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2579
Mailing Address - Country:US
Mailing Address - Phone:702-369-7152
Mailing Address - Fax:
Practice Address - Street 1:3131 LA CANADA ST STE 217
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2579
Practice Address - Country:US
Practice Address - Phone:702-369-7152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32458208600000X, 2086S0102X
NV107812086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503944Medicaid
AZ911702Medicaid
CAXPY205015Medicaid
CAXPY205015Medicaid
NV100503944Medicaid
CAXPY205015Medicaid