Provider Demographics
NPI:1154308120
Name:DAVIS, BRAD RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:RICHARD
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 1:801 E PLANO PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6746
Mailing Address - Country:US
Mailing Address - Phone:972-422-5941
Mailing Address - Fax:972-881-4390
Practice Address - Street 1:801 E PLANO PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6746
Practice Address - Country:US
Practice Address - Phone:972-422-5941
Practice Address - Fax:972-881-4390
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7704207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166819601Medicaid
TX166819607OtherMEDICAID CSHCN
TX8M8930OtherBCBS
TX166819608OtherMEDICAID CSHCN
TX166819603Medicaid
TX166819605Medicaid
TX166819606OtherMEDICAID CSHCN
TX166819602Medicaid
TX166819604Medicaid
TX166819608OtherMEDICAID CSHCN
I06371Medicare UPIN
TX166819603Medicaid
TXTXB107259Medicare PIN
TX8M8930OtherBCBS
TX166819604Medicaid