Provider Demographics
NPI:1811060957
Name:DAVIS, RICHARD SEELIG (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SEELIG
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 WEST DUARTE RD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007
Mailing Address - Country:US
Mailing Address - Phone:626-446-4727
Mailing Address - Fax:626-446-5663
Practice Address - Street 1:624 WEST DUARTE RD
Practice Address - Street 2:#105
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007
Practice Address - Country:US
Practice Address - Phone:626-446-4727
Practice Address - Fax:626-446-5663
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G386200Medicaid
CA00G386200Medicaid
CAG38620Medicare ID - Type Unspecified