Provider Demographics
NPI:1780653584
Name:DAVIS, GREGORY ALLEN
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALLEN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US NAVAL HOSPITAL
Mailing Address - Street 2:
Mailing Address - City:PSC 475 AP
Mailing Address - State:CA
Mailing Address - Zip Code:96350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:US NAVAL HOSPITAL
Practice Address - Street 2:
Practice Address - City:PSC 475 AP
Practice Address - State:CA
Practice Address - Zip Code:96350
Practice Address - Country:US
Practice Address - Phone:045-816-8735
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman