Provider Demographics
NPI:1992741284
Name:DAVIS, ROBERT WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
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 1:41881 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592-4004
Mailing Address - Country:US
Mailing Address - Phone:205-695-9411
Mailing Address - Fax:
Practice Address - Street 1:45020 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592
Practice Address - Country:US
Practice Address - Phone:205-695-0106
Practice Address - Fax:205-695-0502
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00003636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009947165Medicaid
AL51520568OtherBCBS AL PIN
AL51520568OtherBCBS AL PIN
ALC70036Medicare UPIN
AL009947165Medicaid