Provider Demographics
NPI:1629021316
Name:DAVIS, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:DAVIS
Suffix:
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 1:3710 COUNCIL CRST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2904
Mailing Address - Country:US
Mailing Address - Phone:608-575-0413
Mailing Address - Fax:608-238-4940
Practice Address - Street 1:3710 COUNCIL CRST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2904
Practice Address - Country:US
Practice Address - Phone:608-575-0413
Practice Address - Fax:608-238-4940
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30181100Medicaid
WI30181100Medicaid
038C15875Medicare ID - Type Unspecified