Provider Demographics
NPI:1255336855
Name:DAVIS, LENDOL L 'TAD' (MD)
Entity type:Individual
Prefix:
First Name:LENDOL
Middle Name:L 'TAD'
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 1:1902 S IH 35
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3628
Mailing Address - Country:US
Mailing Address - Phone:512-443-9595
Mailing Address - Fax:
Practice Address - Street 1:1902 S IH 35
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-3628
Practice Address - Country:US
Practice Address - Phone:512-443-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0621207VM0101X
TXE6021207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115863602Medicaid
TX8F9860Medicare PIN
TX00R948Medicare PIN
TX8F2803Medicare PIN
TX8F2801Medicare PIN