Provider Demographics
NPI:1942396429
Name:DAVIS, RICHARD H (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1429 COLLEGE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4057
Mailing Address - Country:US
Mailing Address - Phone:209-578-1582
Mailing Address - Fax:209-578-5185
Practice Address - Street 1:1429 COLLEGE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4057
Practice Address - Country:US
Practice Address - Phone:209-578-1582
Practice Address - Fax:209-578-5185
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-01-15
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Provider Licenses
StateLicense IDTaxonomies
CAAD1415923207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-2725185OtherTAX I.D.
CAA23326Medicare UPIN
CA94-2725185OtherTAX I.D.