Provider Demographics
NPI:1912051160
Name:DAVIS, PAUL A (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
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 2587
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35662-2587
Mailing Address - Country:US
Mailing Address - Phone:256-383-4473
Mailing Address - Fax:256-320-7280
Practice Address - Street 1:426 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5521
Practice Address - Country:US
Practice Address - Phone:256-718-4041
Practice Address - Fax:256-718-3665
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23118207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51001589OtherBLUE CROSS BLUE SHIELD
AL009932588Medicaid
AL753040383OtherTAX ID
AL51001584OtherBLUE CROSS BLUE SHIELD
AL753040383OtherTAX ID
AL51001584OtherBLUE CROSS BLUE SHIELD