Provider Demographics
NPI:1275506651
Name:DAVIS, WILLIAM JEFFREY (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEFFREY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BAILEY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17363-8297
Mailing Address - Country:US
Mailing Address - Phone:717-993-2543
Mailing Address - Fax:717-993-2044
Practice Address - Street 1:200 BAILEY DR STE 101
Practice Address - Street 2:
Practice Address - City:STEWARTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17363-8297
Practice Address - Country:US
Practice Address - Phone:717-993-2543
Practice Address - Fax:717-993-2044
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005214L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039846OtherGROUP PTAN
PA001090970Medicaid
PA039846OtherGROUP PTAN
PA001090970Medicaid
PA080186920Medicare PIN