Provider Demographics
NPI:1629252465
Name:DAVIS, ANTHONY K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2605 KENTUCKY AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3800
Mailing Address - Country:US
Mailing Address - Phone:270-415-7653
Mailing Address - Fax:270-575-8359
Practice Address - Street 1:2601 KENTUCKY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3817
Practice Address - Country:US
Practice Address - Phone:270-575-8462
Practice Address - Fax:270-443-0235
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2020-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY49183208600000X
PAMD455950208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100415480Medicaid
KYK152610Medicare PIN