Provider Demographics
NPI:1124287420
Name:DAVIS, THOMAS KEEFE (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KEEFE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:NWT 8328 CB 8116
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-6043
Mailing Address - Fax:314-454-4258
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:STE 2C AND 2D
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6043
Practice Address - Fax:314-454-4258
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2008015429208000000X, 2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid