Provider Demographics
NPI:1710920954
Name:DAVIS, RICHARD O (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:O
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6642207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000001632OtherBLUE CROSS
AL009948595Medicaid
AL051524567OtherBLUE CROSS
AL051521747OtherBLUE CROSS
AL009948605Medicaid
AL051524565OtherBLUE CROSS
AL009948565Medicaid
AL051524568OtherBLUE CROSS
AL000093752OtherBLUE CROSS
AL051521742OtherBLUE CROSS
AL051521745OtherBLUE CROSS
AL009948575Medicaid
AL009949715Medicaid
AL009970085Medicaid
AL009971135Medicaid
AL051521740OtherBLUE CROSS
AL051521746OtherBLUE CROSS
AL009948585Medicaid
AL009970075Medicaid
AL051517984OtherBLUE CROSS