Provider Demographics
NPI:1487735957
Name:DAVIS, WILLIAM K (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:K
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:9840 N BEACH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6184
Practice Address - Country:US
Practice Address - Phone:817-431-3898
Practice Address - Fax:817-379-1161
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7712208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84311SOtherBCBSTX IND PIN
1750369203OtherGRP NPI NUMBER
TX9076046OtherPHCS PIN
TX043988702Medicaid
TX043988703OtherCSHCN
TX1943823OtherUHC PIN
TX7627171OtherAETNA PIN
TXDAVK45553OtherCCHIP PIN
TX1815511OtherFIRSTHEALTH PIN
TX00U87ZOtherBCBSTX GRP PIN
TX2826794OtherCIGNA PIN
TX043988702Medicaid