Individual
DAVID P DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
890 E RIDGELAWN RD, MARTINSVILLE, IL 62442-2551
(217) 382-4191
(217) 382-4248
Mailing address
1005 HEALTH CENTER DR STE 201, MATTOON, IL 61938-4693
(217) 238-6055
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01039458A
IN
207Q00000X
Family Medicine Physician
Primary
036086811
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000079566
ANTHEM BLUE CROSS
IN
01
—
0004400750
AETNA
IL
01
—
006686
HEALTH ALLIANCE
IL
01
—
01225376
BLUE CROSS BLUE SHIELD
IL
01
—
311661293
HEALTH LINK
IL
05
—
311661293001
—
IL
Enumeration date
11/04/2005
Last updated
10/25/2018
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