Provider Demographics
NPI:1629024989
Name:DAVIS, ALVIN V III (MD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:V
Last Name:DAVIS
Suffix:III
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 340
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-0340
Mailing Address - Country:US
Mailing Address - Phone:903-892-1131
Mailing Address - Fax:903-327-8023
Practice Address - Street 1:5016 S US HIGHWAY 75
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4584
Practice Address - Country:US
Practice Address - Phone:903-892-1131
Practice Address - Fax:903-327-8023
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20060087412085R0202X
OK26730174400000X
TXN16072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200782502Medicaid
MO201048907Medicaid
OK200223770Medicaid
TX200782502Medicaid
MO201048907Medicaid
TX8L6402Medicare PIN