Provider Demographics
NPI:1063045516
Name:JOEL M DAVIS MD PHD PLLC
Entity type:Organization
Organization Name:JOEL M DAVIS MD PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-768-1600
Mailing Address - Street 1:PO BOX 2378
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-2378
Mailing Address - Country:US
Mailing Address - Phone:405-768-1600
Mailing Address - Fax:
Practice Address - Street 1:941 W I 35 FRONTAGE RD STE 164
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7375
Practice Address - Country:US
Practice Address - Phone:405-285-2994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty