Provider Demographics
NPI:1528022605
Name:DAVIS, RICHARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5151 BIOINFORMATICS BUILDING
Mailing Address - Street 2:CAMPUS BOX # 7040
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599
Mailing Address - Country:US
Mailing Address - Phone:919-966-5296
Mailing Address - Fax:919-955-1908
Practice Address - Street 1:5151 BIOINFORMATICS
Practice Address - Street 2:CAMPUS BOX 7040
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-966-5296
Practice Address - Fax:919-966-1908
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC13465207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL5633Medicaid
C687572326Medicare ID - Type Unspecified
SCTL5633Medicaid
SCC687572326Medicare PIN