Provider Demographics
NPI:1720536618
Name:DAVIS, RICHARD (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0001
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4630 AMBASSADOR CAFFERY PKWY STE 302
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6950
Practice Address - Country:US
Practice Address - Phone:337-470-3580
Practice Address - Fax:337-470-3586
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2021-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA303582363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical