Provider Demographics
NPI:1891086989
Name:DAVIS, DREW BENNETT (MD)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:BENNETT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 16TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-2742
Mailing Address - Country:US
Mailing Address - Phone:812-279-0148
Mailing Address - Fax:812-279-5155
Practice Address - Street 1:1901 16TH ST STE 2
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-2742
Practice Address - Country:US
Practice Address - Phone:812-279-0148
Practice Address - Fax:812-279-5155
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075373A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300032250Medicaid
OH0140400Medicaid
IN201290430Medicaid
INP01575474OtherRAILROAD MEDICARE
OH0140400Medicaid
OHH352490Medicare PIN