Provider Demographics
NPI:1942739396
Name:DAVIS, PATRICK LLOYD (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LLOYD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 W MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1024
Mailing Address - Country:US
Mailing Address - Phone:630-897-6044
Mailing Address - Fax:630-897-0180
Practice Address - Street 1:3310 W MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1024
Practice Address - Country:US
Practice Address - Phone:630-897-6044
Practice Address - Fax:630-897-0180
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.156232207V00000X
OK390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program