Provider Demographics
NPI:1629186770
Name:DAVIS, CARL RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:RICHARD
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 1:1102 NE PARVIN ROAD
Mailing Address - Street 2:#302
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116
Mailing Address - Country:US
Mailing Address - Phone:816-560-3322
Mailing Address - Fax:
Practice Address - Street 1:1102 NE PARVIN ROAD
Practice Address - Street 2:#302
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116
Practice Address - Country:US
Practice Address - Phone:816-560-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006023528207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006023528OtherMEDICAL LICENSE NUMBER