Provider Demographics
NPI:1487187910
Name:DAVIS, DANIEL ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ADAM
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7500 N DREAMY DRAW DR STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4668
Mailing Address - Country:US
Mailing Address - Phone:480-882-4545
Mailing Address - Fax:480-692-6874
Practice Address - Street 1:11851 N 51ST AVE STE B110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2823
Practice Address - Country:US
Practice Address - Phone:480-882-4545
Practice Address - Fax:623-207-7410
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2023-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ61526207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ079662Medicaid