Provider Demographics
NPI:1861523029
Name:ROBERT A DAVIS MD INC
Entity type:Organization
Organization Name:ROBERT A DAVIS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JUCHAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-294-2203
Mailing Address - Street 1:3443 VILLA LN STE 10
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6417
Mailing Address - Country:US
Mailing Address - Phone:707-294-2203
Mailing Address - Fax:707-252-9012
Practice Address - Street 1:3443 VILLA LN STE 10
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6417
Practice Address - Country:US
Practice Address - Phone:707-294-2203
Practice Address - Fax:707-252-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23265174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG232650Medicaid
CAOOG232650Medicaid
A41898Medicare UPIN