Provider Demographics
NPI:1528037975
Name:DAVIS, CORNELIUS ALEXANDER III (MD)
Entity Type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:ALEXANDER
Last Name:DAVIS
Suffix:III
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:PO BOX 2868
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-2868
Mailing Address - Country:US
Mailing Address - Phone:713-714-4040
Mailing Address - Fax:713-588-1850
Practice Address - Street 1:5373 W ALABAMA STREET
Practice Address - Street 2:STE 204
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056
Practice Address - Country:US
Practice Address - Phone:713-714-4044
Practice Address - Fax:713-588-1850
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7349208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165376801Medicaid
TX00860VMedicare ID - Type Unspecified
TX165376801Medicaid