Provider Demographics
NPI:1922183680
Name:DAVIS, JEFFREY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8072
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-996-5225
Mailing Address - Fax:314-991-0943
Practice Address - Street 1:3015 N BALLAS RD
Practice Address - Street 2:DEPT EMERGENCY MEDICINE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2329
Practice Address - Country:US
Practice Address - Phone:314-966-5000
Practice Address - Fax:314-747-3338
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-12-20
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Provider Licenses
StateLicense IDTaxonomies
MO2013030518208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200012969Medicaid
00A739920Medicare ID - Type Unspecified
CA00A739920Medicaid