Individual
SAMUEL P DAVIS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2707 MEDICAL OFFICE PL, GOLDSBORO, NC 27534-9458
(919) 735-9146
(919) 735-0582
Mailing address
2000 PERIMETER PARK DR STE 200, MORRISVILLE, NC 27560-8442
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01070226A
IN
207Y00000X
Otolaryngology Physician
Primary
9900469
NC
207YS0123X
Facial Plastic Surgery Physician
01070226A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040014729
PALMETTO GBA-RR MEDICARE
NC
05
—
201036750
—
IN
05
—
891214V
—
NC
Enumeration date
06/27/2006
Last updated
05/07/2021
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