Individual
DR. MARK L DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1739 E BEVERLY AVE STE 102, KINGMAN, AZ 86409-3593
(928) 681-8693
(928) 681-8694
Mailing address
3269 N STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 757-2101
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
007480
AZ
207X00000X
Orthopaedic Surgery Physician
5101012747
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200000001852
PHYSICIANS HEALTH PLAN
MI
01
—
200C313650
BCBS MI
MI
01
—
200C31650
BLUECARE NETWORK
MI
01
—
2053302675
BLUE SHIELD
MI
01
—
300040412
TRICARE
MI
05
—
4837808
—
MI
Enumeration date
06/10/2005
Last updated
04/11/2022
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