Provider Demographics
NPI:1992731061
Name:DAVIS, HARRY E II (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:E
Last Name:DAVIS
Suffix:II
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 1:4800 ALBERTA AVE
Mailing Address - Street 2:STE 101 CREDENTIALING OFFICE
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2709
Mailing Address - Country:US
Mailing Address - Phone:915-215-5205
Mailing Address - Fax:915-215-8641
Practice Address - Street 1:4801 ALBERTA AVE.
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905
Practice Address - Country:US
Practice Address - Phone:915-545-6640
Practice Address - Fax:915-545-6634
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106006302Medicaid
TNG56721Medicare UPIN
TX106006302Medicaid