Provider Demographics
NPI:1194978593
Name:LARRY R DAVIS M.D.
Entity type:Organization
Organization Name:LARRY R DAVIS M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-599-8300
Mailing Address - Street 1:231 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMO HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5620
Mailing Address - Country:US
Mailing Address - Phone:210-599-8300
Mailing Address - Fax:210-599-8853
Practice Address - Street 1:231 GRANT AVE
Practice Address - Street 2:
Practice Address - City:ALAMO HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:78209-5620
Practice Address - Country:US
Practice Address - Phone:210-599-8300
Practice Address - Fax:210-599-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3888173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID