Provider Demographics
NPI:1972611556
Name:DAVIS, CRAIG MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:MATTHEW
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 1:8440 W LAKE MEAD BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7648
Mailing Address - Country:US
Mailing Address - Phone:702-489-4838
Mailing Address - Fax:702-489-4837
Practice Address - Street 1:8440 W LAKE MEAD BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7648
Practice Address - Country:US
Practice Address - Phone:702-489-4838
Practice Address - Fax:702-489-4837
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23337207ZD0900X, 207N00000X
OK48201223S0112X
NV10713207ZD0900X, 207ND0900X, 207ND0101X, 207NS0135X, 207N00000X, 207ZP0101X, 208D00000X
AZ31661207N00000X, 207ND0900X, 207ZD0900X, 207ZP0101X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G80584Medicare UPIN