Provider Demographics
NPI:1982628293
Name:DAVIS, JIM (DO)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2404 RIO GRANDE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-4813
Mailing Address - Country:US
Mailing Address - Phone:512-569-5795
Mailing Address - Fax:512-473-2605
Practice Address - Street 1:3839 BEE CAVE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6401
Practice Address - Country:US
Practice Address - Phone:512-569-5795
Practice Address - Fax:512-473-2605
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH4085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000061NK00OtherBCBS TEXAS