Provider Demographics
NPI:1750647111
Name:RICHARD S. DAVIS M.D. INC.
Entity type:Organization
Organization Name:RICHARD S. DAVIS M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SEELIG
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-446-4727
Mailing Address - Street 1:624 W. DUARTE ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9256
Mailing Address - Country:US
Mailing Address - Phone:626-446-4727
Mailing Address - Fax:626-446-5663
Practice Address - Street 1:624 W. DUARTE ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9256
Practice Address - Country:US
Practice Address - Phone:626-446-4727
Practice Address - Fax:626-446-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38620261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47541Medicare UPIN