Provider Demographics
NPI:1891723680
Name:DAVIS, WILLIAM SIMPSON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SIMPSON
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 1:1414 W LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1184
Mailing Address - Country:US
Mailing Address - Phone:859-737-0001
Mailing Address - Fax:859-737-6658
Practice Address - Street 1:1414 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1184
Practice Address - Country:US
Practice Address - Phone:859-737-0001
Practice Address - Fax:859-737-6658
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21156207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64211568Medicaid
KY0975561Medicare PIN
KY64211568Medicaid