Provider Demographics
NPI:1396774782
Name:DAVIS, BRETT C (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:1000 BRECKENRIDGE ST STE 302A
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0877
Practice Address - Country:US
Practice Address - Phone:270-228-0210
Practice Address - Fax:270-228-2089
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY31158207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64311582Medicaid
IN100474890Medicaid
IN100474890Medicaid
KY000000045768OtherANTHEM BC/BS
KY64311582Medicaid
IN100474890Medicaid
KY000000045768OtherANTHEM BC/BS