Provider Demographics
NPI:1912068438
Name:DAVIS, THOMAS MORREY (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MORREY
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 1:8 NORTH GRANT STREET
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1223
Mailing Address - Country:US
Mailing Address - Phone:317-858-8800
Mailing Address - Fax:317-858-8838
Practice Address - Street 1:8 NORTH GRANT STREET
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1223
Practice Address - Country:US
Practice Address - Phone:317-858-8800
Practice Address - Fax:317-858-8838
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000974A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
D74259Medicare UPIN