Provider Demographics
NPI:1225099161
Name:DAVIS, FRED NEAL (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:NEAL
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 1:6619 N SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-2637
Mailing Address - Country:US
Mailing Address - Phone:616-940-0660
Mailing Address - Fax:
Practice Address - Street 1:6619 N SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-2637
Practice Address - Country:US
Practice Address - Phone:616-450-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10641208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4532270-10Medicaid
7000027051OtherPRIORITY HEALTH MEDICAID
050044374OtherRAILROAD MEDICARE
11908OtherHEALTH PLAN OF MICHIGAN
MI4552970-10Medicaid
2019450OtherPHYSICIANS HEALTH PLAN
MI550410724OtherBLUE CROSS BLUE SHIELD
7582081OtherCIGNA
4098753OtherAETNA
7000027051OtherPRIORITY HEALTH
MI4532270-10Medicaid
7582081OtherCIGNA