Provider Demographics
NPI:1154389906
Name:DAVIS, WINSTON BROOKS (MD)
Entity type:Individual
Prefix:
First Name:WINSTON
Middle Name:BROOKS
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 1:714 N SENATE AVE
Mailing Address - Street 2:STE EF205
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3763
Mailing Address - Country:US
Mailing Address - Phone:317-715-6402
Mailing Address - Fax:317-715-6415
Practice Address - Street 1:714 N SENATE AVE
Practice Address - Street 2:STE EF205
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3763
Practice Address - Country:US
Practice Address - Phone:317-715-6402
Practice Address - Fax:317-715-6415
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050878A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN959090AAA6OtherMEDICARE PTAN
INP00733995OtherRAILROAD MEDICARE
INP00800396OtherRAILROAD MEDICARE
INP00163349OtherRR MEDICARE
INP00264111OtherRAILROAD MEDICARE
IN200128460Medicaid
IN219950G4Medicare PIN
IN980210EEMedicare PIN
INP00163349OtherRR MEDICARE
INP00800396OtherRAILROAD MEDICARE