Provider Demographics
NPI:1760499057
Name:DAVIS, LARRY E (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1501 SAN PEDRO DR SE
Mailing Address - Street 2:NEUROLOGY SERVICE (127)
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-5153
Mailing Address - Country:US
Mailing Address - Phone:505-256-2752
Mailing Address - Fax:505-256-2870
Practice Address - Street 1:1501 SAN PEDRO DR SE
Practice Address - Street 2:NEUROLOGY SERVICE (127)
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5153
Practice Address - Country:US
Practice Address - Phone:505-256-2752
Practice Address - Fax:505-256-2870
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM75-1342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology