Provider Demographics
NPI:1245275270
Name:DAVIS, VIRGIL WELCH III (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGIL
Middle Name:WELCH
Last Name:DAVIS
Suffix:III
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 571117
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84157-1117
Mailing Address - Country:US
Mailing Address - Phone:801-507-9700
Mailing Address - Fax:
Practice Address - Street 1:5171 S COTTONWOOD ST STE 740
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5705
Practice Address - Country:US
Practice Address - Phone:801-507-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6799020-1205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A766490Medicaid
CA00A766490Medicare PIN
CAG73775Medicare UPIN
CA00A766492Medicare PIN