Provider Demographics
NPI:1932214608
Name:DAVIS, ANDREW JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOHN
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 1:143 SUGAR PINE CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-2472
Mailing Address - Country:US
Mailing Address - Phone:936-647-8311
Mailing Address - Fax:936-226-0147
Practice Address - Street 1:143 SUGAR PINE CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-2472
Practice Address - Country:US
Practice Address - Phone:936-647-8311
Practice Address - Fax:936-226-0147
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0074PAOtherBLUE CROSS
TXP00390413OtherMEDICARE B - RAILROAD
TX00658MMedicare PIN
TX0074PAOtherBLUE CROSS