Provider Demographics
NPI:1134163611
Name:DAVIS, JONATHAN L (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-644-6232
Mailing Address - Fax:405-644-5493
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:STE 3010
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-644-6232
Practice Address - Fax:405-644-5493
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14691207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100051410AMedicaid
OK100051410AMedicaid
D34570Medicare UPIN
249435104Medicare ID - Type Unspecified