Provider Demographics
NPI:1477552909
Name:DAVIS, BARNEY MCCOY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BARNEY
Middle Name:MCCOY
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 42958
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-2958
Mailing Address - Country:US
Mailing Address - Phone:803-240-4704
Mailing Address - Fax:
Practice Address - Street 1:3329 W DANBURY DR
Practice Address - Street 2:F110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-1810
Practice Address - Country:US
Practice Address - Phone:803-240-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC236582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD77685Medicare UPIN