Provider Demographics
NPI:1871591354
Name:DAVIS, DAVID GARLAND (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GARLAND
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11623 ANGUS RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4003
Mailing Address - Country:US
Mailing Address - Phone:512-346-7170
Mailing Address - Fax:
Practice Address - Street 1:11623 ANGUS RD
Practice Address - Street 2:SUITE 15
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4003
Practice Address - Country:US
Practice Address - Phone:512-346-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX E-0875207X00000X, 207XS0106X, 207XS0114X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX E-0875OtherMEDICAL LICENSE
TXCOR38LMedicare ID - Type Unspecified
TXA36112Medicare UPIN
TX4818240001Medicare NSC