Provider Demographics
NPI:1578504007
Name:DAVIS, WILLIAM GRANT (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GRANT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2386
Mailing Address - Street 2:BRAZOS VALLEY PATHOLOGY
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664
Mailing Address - Country:US
Mailing Address - Phone:903-944-8991
Mailing Address - Fax:512-597-2713
Practice Address - Street 1:800 E. DAWSON
Practice Address - Street 2:TRINITY MOTHER FRANCES HOSPITAL
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:512-814-0298
Practice Address - Fax:512-597-2713
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8181207ZP0102X
MO2005020830207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB134816OtherMEDICARE
TX0808107Medicaid