Provider Demographics
NPI:1962488262
Name:H GORDON DAVIS III MD SC
Entity Type:Organization
Organization Name:H GORDON DAVIS III MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OBSTETRICIAN GYNECOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:847-884-0906
Mailing Address - Street 1:2500 W HIGGINS RD
Mailing Address - Street 2:#640
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-5220
Mailing Address - Country:US
Mailing Address - Phone:847-884-0906
Mailing Address - Fax:847-884-0994
Practice Address - Street 1:2500 W HIGGINS RD
Practice Address - Street 2:#640
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60195-5220
Practice Address - Country:US
Practice Address - Phone:847-884-0906
Practice Address - Fax:847-884-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31602229OtherBCBS
IL31602229OtherBCBS
IL768150Medicare ID - Type Unspecified