Active NPI
Gary L. Davis, M.D.
- Hepatology Physician
- Dallas, TX
National Provider Identifier
1265479364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hepatology Physician
- License
- L4323
- Practice address
- 3410 Worth Street
Suite 860
Dallas, TX 75246 - Phone
- (214) 820-8500
- Fax
- (214) 820-8168
- NPI assigned
- May 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | L4323 | TX | |
| Hepatology Physician | 207RI0008X | L4323 | TX | Primary |
| Transplant Hepatology Physician | 207RT0003X | L4323 | TX |
Addresses
Primary practice location
3410 Worth Street
Suite 860
Dallas, TX 75246
Mailing address
201 S Ocean Grande Dr
Suite PH4
Ponte Vedra Beach, FL 32082-6515
Phone (214) 783-2563
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 157390901 | Medicaid | TX | |
| 157390902 | Medicaid | TX | |
| 8G0555 | Other | TX | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L4323 | TX | MD | Hepatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404345600000",
"number": "1265479364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 S OCEAN GRANDE DR",
"address_2": "SUITE PH4",
"city": "PONTE VEDRA BEACH",
"state": "FL",
"postal_code": "320826515",
"telephone_number": "214-783-2563",
"fax_number": "214-820-8168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3410 WORTH STREET",
"address_2": "SUITE 860",
"city": "DALLAS",
"state": "TX",
"postal_code": "75246",
"telephone_number": "214-820-8500",
"fax_number": "214-820-8168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "GARY",
"middle_name": "L.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-31",
"last_updated": "2014-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "TX",
"license": "L4323",
"primary": false
},
{
"code": "207RI0008X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hepatology",
"state": "TX",
"license": "L4323",
"primary": true
},
{
"code": "207RT0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Transplant Hepatology",
"state": "TX",
"license": "L4323",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "157390901",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "157390902",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8G0555",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.