Provider Demographics
NPI:1952541088
Name:DAVIS, RANDY JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:JOHN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:8585 N STEMMONS FWY STE S-105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-3836
Mailing Address - Country:US
Mailing Address - Phone:469-502-4772
Mailing Address - Fax:214-459-3709
Practice Address - Street 1:8585 N STEMMONS FWY STE S-105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-3836
Practice Address - Country:US
Practice Address - Phone:469-502-4772
Practice Address - Fax:214-459-3709
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN2053208VP0014X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine