Provider Demographics
NPI:1922202969
Name:DAVIS, LARRY (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
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 1:5015 ADDISON CIR
Mailing Address - Street 2:#532
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3308
Mailing Address - Country:US
Mailing Address - Phone:214-868-7413
Mailing Address - Fax:
Practice Address - Street 1:10375 RICHMOND AVE
Practice Address - Street 2:SUITE 1575
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4143
Practice Address - Country:US
Practice Address - Phone:713-541-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE02237Medicare UPIN