Provider Demographics
NPI:1578564332
Name:DAVIS, ROBERT A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:ECU PHYSICIANS
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203-B EARNHARDT DR.
Practice Address - Street 2:ECU PHYSICIANS SURGERY CHOWAN HOSPITAL
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932
Practice Address - Country:US
Practice Address - Phone:252-482-5868
Practice Address - Fax:252-482-7953
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-11-23
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Provider Licenses
StateLicense IDTaxonomies
NC30145208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC020051953OtherRAILROAD MEDICARE
NC27914OtherBCBS NC
NC8927914Medicaid
NC8927914Medicaid
NC203816BMedicare PIN