Provider Demographics
NPI:1114001583
Name:DAVIS, ALONZO JAMES IV (MD)
Entity type:Individual
Prefix:
First Name:ALONZO
Middle Name:JAMES
Last Name:DAVIS
Suffix:IV
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 1:221A PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4303
Mailing Address - Country:US
Mailing Address - Phone:252-726-5767
Mailing Address - Fax:252-726-7573
Practice Address - Street 1:221A PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4303
Practice Address - Country:US
Practice Address - Phone:252-726-5767
Practice Address - Fax:252-726-7573
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8927768Medicaid
NC27291OtherBLUE CROSS/BLUE SHIELD NC
NC27291OtherBLUE CROSS/BLUE SHIELD NC
NCG18028Medicare UPIN