Provider Demographics
NPI:1659352045
Name:DAVIS, STEVEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
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 1:1600 W COLLEGE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3575
Mailing Address - Country:US
Mailing Address - Phone:214-689-7806
Mailing Address - Fax:214-689-5970
Practice Address - Street 1:1600 W COLLEGE ST STE 130
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3575
Practice Address - Country:US
Practice Address - Phone:214-689-7806
Practice Address - Fax:214-689-5970
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RI00011X174400000X
TXH7719207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135885509Medicaid
TX8352M0Medicare PIN
TX135885509Medicaid