Provider Demographics
NPI:1174597538
Name:DAVIS, HENRY J (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:J
Last Name:DAVIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2723 S 7TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3558
Mailing Address - Country:US
Mailing Address - Phone:812-238-1730
Mailing Address - Fax:812-242-1565
Practice Address - Street 1:2723 S 7TH ST
Practice Address - Street 2:SUITE P
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3562
Practice Address - Country:US
Practice Address - Phone:812-232-8594
Practice Address - Fax:812-232-5565
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-07-15
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Provider Licenses
StateLicense IDTaxonomies
IN01044622A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200084240Medicaid
IN660002905OtherRAILROAD MEDICARE
IN660002905OtherRAILROAD MEDICARE
IN147180KMedicare ID - Type Unspecified