Theodore Edwin Clyde Davies, M.D.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

16229 Issued in KY

Practice address

2603 Kentucky Ave
Ste 404
Paducah, KY 42003-3814

Phone

(270) 443-6472

Fax

(270) 442-1649

NPI assigned

Jun 1, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Paducah Neurosurgical Associates, PSC

  • Neurological Surgery Physician
  • Paducah, KY
  • NPI 1962518498
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210118400000",
    "number": "1487656658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2603 KENTUCKY AVE",
            "address_2": "STE 404",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420033814",
            "telephone_number": "270-443-6472",
            "fax_number": "270-442-1649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 KENTUCKY AVE",
            "address_2": "STE 404",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420033814",
            "telephone_number": "270-443-6472",
            "fax_number": "270-442-1649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIES",
        "first_name": "THEODORE",
        "middle_name": "EDWIN CLYDE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2008-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "KY",
            "license": "16229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00391203",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64162290",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Davenport
• Julie Ann Davenport, M.D.
• David J, Elrod, DMD. a Professional Service Corporation
• David M. West MD PSC
• Heidi Atkinson Davies, APRN
• Davis Drugs of Lone Oak Inc
• Anthony K Davis, MD
• Bethany Ann Davis
• Brittney Lynn Davis, LPCA
• Charles King Davis Jr., MD

• Neurological Surgery Physician in Paducah, KY
• Providers in Paducah, KY by specialty
• Neurological Surgery Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.