Provider Demographics
NPI:1356520811
Name:GREGORY L DAVIS MD INC
Entity type:Organization
Organization Name:GREGORY L DAVIS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-332-9703
Mailing Address - Street 1:1560 HUMBOLDT RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9101
Mailing Address - Country:US
Mailing Address - Phone:530-332-9703
Mailing Address - Fax:530-894-8505
Practice Address - Street 1:1560 HUMBOLDT RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-9101
Practice Address - Country:US
Practice Address - Phone:530-332-9703
Practice Address - Fax:530-894-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G736380Medicaid
CA00G736380Medicaid