Provider Demographics
NPI:1679677066
Name:DAVIS, ERNEST EDMUND (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:EDMUND
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:UNITED STATES DEPARTMENT OF STATE, M/MED/QI
Mailing Address - Street 2:2401 E. STREET, NW, SA-1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20522-0102
Mailing Address - Country:US
Mailing Address - Phone:202-662-1682
Mailing Address - Fax:202-663-3673
Practice Address - Street 1:UNITED STATES DEPARTMENT OF STATE, M/MED/QI
Practice Address - Street 2:2401 E. STREET, NW, SA-1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-0102
Practice Address - Country:US
Practice Address - Phone:202-662-1682
Practice Address - Fax:202-663-3673
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9N10174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR9N10OtherMEDICAL LICENSE