Individual
DR. ANTHONY DEWAYNE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1379 BRAD CIRCLE STE A, LINDALE, TX 75771
(903) 881-5165
(903) 881-5175
Mailing address
1379 BRAD CIRCLE STE A, LINDALE, TX 75771
(903) 881-5165
(903) 881-5175
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K7710
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116319807
—
TX
01
—
P00017436
MEDICARE RR
—
Enumeration date
06/14/2006
Last updated
03/11/2020
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