Provider Demographics
NPI:1760458160
Name:DAVIS, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 TER HEUN DRIVE
Mailing Address - Street 2:FALMOUTH HOSPITAL
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540
Mailing Address - Country:US
Mailing Address - Phone:508-457-3929
Mailing Address - Fax:508-457-3839
Practice Address - Street 1:100 TER HEUN DRIVE
Practice Address - Street 2:FALMOUTH HOSPITAL EMERGENCY DEPARTMENT
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-457-3929
Practice Address - Fax:508-457-3839
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA159478207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA439368OtherHPHC
MAJ21029OtherBC BS
A29323Medicare ID - Type Unspecified
MAJ21029OtherBC BS