Provider Demographics
NPI:1720068851
Name:DAVIS, ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
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 1:701 COOPER RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3800
Mailing Address - Country:US
Mailing Address - Phone:856-783-5000
Mailing Address - Fax:856-783-5041
Practice Address - Street 1:1605 E EVESHAM RD STE 100A
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1437
Practice Address - Country:US
Practice Address - Phone:856-741-7100
Practice Address - Fax:856-424-2629
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB0570440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5510503Medicaid
NJ5510503Medicaid
NJF51868Medicare UPIN