Provider Demographics
NPI:1538306725
Name:RICHARD T. DAVIS, MD PC
Entity Type:Organization
Organization Name:RICHARD T. DAVIS, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-889-3111
Mailing Address - Street 1:1050 SW 3RD AVE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2193
Mailing Address - Country:US
Mailing Address - Phone:541-889-3111
Mailing Address - Fax:541-889-3999
Practice Address - Street 1:1050 SW 3RD AVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2193
Practice Address - Country:US
Practice Address - Phone:541-889-3111
Practice Address - Fax:541-889-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28858207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty