Provider Demographics
NPI:1972521318
Name:DAVIS, JERRY FRANCIS (MD)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:FRANCIS
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 1:221 W COLORADO BLVD STE 730
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2357
Mailing Address - Country:US
Mailing Address - Phone:214-941-5200
Mailing Address - Fax:214-948-8870
Practice Address - Street 1:221 W COLORADO BLVD STE 730
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2357
Practice Address - Country:US
Practice Address - Phone:214-941-5200
Practice Address - Fax:214-948-8870
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7989207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124073102Medicaid
TX84M366Medicare ID - Type Unspecified
TX124073102Medicaid