Provider Demographics
NPI:1891758140
Name:DAVIS, JEFFREY DEAN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DEAN
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 1:1011 EAST JEFFERSON ST
Mailing Address - Street 2:STE 202
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5354
Mailing Address - Country:US
Mailing Address - Phone:434-977-7950
Mailing Address - Fax:434-295-4470
Practice Address - Street 1:1011 EAST JEFFERSON ST
Practice Address - Street 2:STE 202
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5354
Practice Address - Country:US
Practice Address - Phone:434-977-7950
Practice Address - Fax:434-295-4470
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006009395Medicaid
VA020359OtherBCBS
VA110005167Medicare PIN
F56014Medicare UPIN