Provider Demographics
NPI:1588767826
Name:DAVIS, OMAR RASHAD (MD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:RASHAD
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 1:2200 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4205
Mailing Address - Country:US
Mailing Address - Phone:901-726-1130
Mailing Address - Fax:
Practice Address - Street 1:2200 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4205
Practice Address - Country:US
Practice Address - Phone:901-726-1130
Practice Address - Fax:901-726-1132
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000036199207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI49076Medicare UPIN
TN3336823Medicare ID - Type UnspecifiedPROVIDER NUMBER