Provider Demographics
NPI:1770585440
Name:DAVIS, LEON J (MD)
Entity type:Individual
Prefix:MR
First Name:LEON
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:102 N PINE ST
Mailing Address - Street 2:BLUE HILL CLINIC
Mailing Address - City:BLUE HILL
Mailing Address - State:NE
Mailing Address - Zip Code:68930-5532
Mailing Address - Country:US
Mailing Address - Phone:402-756-2141
Mailing Address - Fax:402-756-2142
Practice Address - Street 1:102 N PINE ST
Practice Address - Street 2:BLUE HILL CLINIC
Practice Address - City:BLUE HILL
Practice Address - State:NE
Practice Address - Zip Code:68930-5532
Practice Address - Country:US
Practice Address - Phone:402-756-2141
Practice Address - Fax:402-756-2142
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE13349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06154OtherBLUE CROSS BLUE SHIELD NE
096853006OtherMEDICARE PTAN
NEA72963Medicare UPIN