Active NPI
Joseph Leslie Davis, MD
- Family Medicine Physician
- Longview, WA
National Provider Identifier
1053421586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 00019590
- Practice address
- 2807 36TH Ave
Longview, WA 98632-5309 - Phone
- (360) 425-8365
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 00019590 | WA | Primary |
Addresses
Primary practice location
2807 36TH Ave
Longview, WA 98632-5309
Mailing address
1230 7TH Ave
C/O Kaiser Permanente
Longview, WA 98632-3166
Phone (360) 425-8365
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180420001474 | WA | Order and Referring Only - Family Practice | 6901981935 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00019590 | WA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366588800000",
"number": "1053421586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1230 7TH AVE",
"address_2": "C/O KAISER PERMANENTE",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986323166",
"telephone_number": "360-425-8365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2807 36TH AVE",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986325309",
"telephone_number": "360-425-8365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JOSEPH",
"middle_name": "LESLIE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2013-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "00019590",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.