Provider Demographics
NPI:1992962757
Name:DAVIS, ROY KIM (MD)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:KIM
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-233-4400
Mailing Address - Fax:801-233-4410
Practice Address - Street 1:181 E MEDICAL TOWER DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4872
Practice Address - Country:US
Practice Address - Phone:801-314-7840
Practice Address - Fax:801-314-4891
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2020-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT169811-1205207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000064097Medicare PIN