Provider Demographics
NPI:1679558589
Name:DAVIS, JEFFREY D (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:314 E MCPHERSON ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3557
Mailing Address - Country:US
Mailing Address - Phone:660-627-5757
Mailing Address - Fax:660-627-5802
Practice Address - Street 1:RR 1 BOX 55
Practice Address - Street 2:SIGLER AVE.
Practice Address - City:MEMPHIS
Practice Address - State:MO
Practice Address - Zip Code:63555-9726
Practice Address - Country:US
Practice Address - Phone:660-465-7037
Practice Address - Fax:660-465-7350
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2001023603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208313106Medicaid
MO208313106Medicaid
MO006012165Medicare PIN