Provider Demographics
NPI:1386740462
Name:DAVIS, VICTOR M (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
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:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:ST IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-0679
Mailing Address - Country:US
Mailing Address - Phone:406-745-4444
Mailing Address - Fax:406-745-4907
Practice Address - Street 1:101 ARROW ST
Practice Address - Street 2:
Practice Address - City:ST IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-0679
Practice Address - Country:US
Practice Address - Phone:406-745-4444
Practice Address - Fax:406-745-4907
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0012478Medicaid
MT870023511OtherRAILROAD MEDICARE
MT95610OtherBLUE CROSS BLUE SHIELD
D45193Medicare UPIN
MT000081036Medicare ID - Type Unspecified