Provider Demographics
NPI:1760595557
Name:DAVIS, ALEX JUNIUS (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JUNIUS
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 NORTH BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4043
Mailing Address - Country:US
Mailing Address - Phone:225-928-7065
Mailing Address - Fax:225-928-7021
Practice Address - Street 1:4560 NORTH BLVD STE 119
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4043
Practice Address - Country:US
Practice Address - Phone:225-928-7065
Practice Address - Fax:225-928-7021
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD068R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1359891Medicaid
LA0633220001Medicare NSC
LA56038Medicare PIN
LA1359891Medicaid