Provider Demographics
NPI:1982824421
Name:DAVIS, ROBERT EARLE
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EARLE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:EARLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4120 STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-5623
Mailing Address - Country:US
Mailing Address - Phone:518-566-9439
Mailing Address - Fax:
Practice Address - Street 1:4120 STATE ROUTE 9
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-5623
Practice Address - Country:US
Practice Address - Phone:518-566-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092142207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology