Provider Demographics
NPI:1952344947
Name:DAVIS, KEITH E (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:E
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 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:910-235-3428
Practice Address - Street 1:205 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8798
Practice Address - Country:US
Practice Address - Phone:910-295-9211
Practice Address - Fax:910-235-3428
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700524207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1043ROtherBCBS NC PROVIDER#
NC195050OtherMEDCOST
NC80115OtherMEDCOST PROVIDER#
NC060042503OtherPALMETTO GBA PROVIDER#
SCN0052BOtherSC MEDICAID PROV#
NCFH2000105OtherFIRSTCAROLINACARE PROV.#
NC2501565OtherEVERCARE
NC891043RMedicaid
F71681Medicare UPIN
NC891043RMedicaid
NCFH2000105OtherFIRSTCAROLINACARE PROV.#