Provider Demographics
NPI:1588755821
Name:DAVIS, WILLIAM H (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
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 1:1061 E MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5724
Mailing Address - Country:US
Mailing Address - Phone:530-273-3733
Mailing Address - Fax:530-273-3758
Practice Address - Street 1:1061 E MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5724
Practice Address - Country:US
Practice Address - Phone:530-273-3733
Practice Address - Fax:530-273-3758
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG5086602086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G508661Medicaid
CABD2214031OtherDEA
A51834Medicare UPIN
00G508660Medicare ID - Type Unspecified