Provider Demographics
NPI:1669665592
Name:WILLIAM DAVIS MD, INC
Entity Type:Organization
Organization Name:WILLIAM DAVIS MD, INC
Other - Org Name:MOBILE PHYSICIAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-461-3717
Mailing Address - Street 1:7877 PARKWAY DRIVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2000
Mailing Address - Country:US
Mailing Address - Phone:619-461-3717
Mailing Address - Fax:619-461-5941
Practice Address - Street 1:7877 PARKWAY DRIVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2000
Practice Address - Country:US
Practice Address - Phone:619-461-3717
Practice Address - Fax:619-461-5941
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM DAVIS MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-23
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR052467247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR052467Medicare PIN