Provider Demographics
NPI:1447371646
Name:DAVIS, HARVEY CHARLES (DPM)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:CHARLES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1911
Mailing Address - Country:US
Mailing Address - Phone:619-283-6881
Mailing Address - Fax:619-330-2697
Practice Address - Street 1:4115 OHIO ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1911
Practice Address - Country:US
Practice Address - Phone:619-283-6881
Practice Address - Fax:619-330-2697
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1402213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1402Medicare ID - Type Unspecified
CAT19101Medicare UPIN