# ROGER W. DAVIS, MD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124274949
- **Authorized official:** ROGER W DAVIS (OWNER)
- **Authorized official phone:** (719) 543-9202

## Contact information

- **Practice address:** 511 W 29TH ST, SUITE B, PUEBLO, CO 81008-1128
- **Practice address phone:** (719) 543-9202
- **Practice address fax:** (719) 543-9204
- **Mailing address:** 511 W 29TH ST, SUITE B, PUEBLO, CO 81008-1128
- **Mailing address phone:** (719) 543-9202
- **Mailing address fax:** (719) 543-9204

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 30919 | CO | Yes |

## Other

- **Enumeration date:** 08/12/2008
- **Last updated:** 08/12/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 38529343 | — | CO |