Provider Demographics
NPI:1265493134
Name:DAVIS, LEON NOLAN JR (MD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:NOLAN
Last Name:DAVIS
Suffix:JR
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:PO BOX 230577
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-0577
Mailing Address - Country:US
Mailing Address - Phone:334-262-2071
Mailing Address - Fax:334-262-2832
Practice Address - Street 1:1725 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-262-2071
Practice Address - Fax:334-262-2832
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000022924Medicaid
AL110196628OtherPALMETTO
AL051022924OtherBCBS AL
F32977Medicare UPIN
AL000022924Medicaid