Provider Demographics
NPI:1790795813
Name:DAVIES, JEFFREY PHILLIPS I (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PHILLIPS
Last Name:DAVIES
Suffix:I
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3644
Mailing Address - Country:US
Mailing Address - Phone:508-778-4777
Mailing Address - Fax:508-771-9555
Practice Address - Street 1:433 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3644
Practice Address - Country:US
Practice Address - Phone:508-778-4777
Practice Address - Fax:508-771-9555
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213386207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA15667OtherHARVARD PILGRIM
213386OtherTUFTS
J25858OtherBCBS
465295OtherUSFHP
A3512502Medicare PIN
MA5175530001Medicare NSC
465295OtherUSFHP