Tad Leon Davis, MD
Individual provider Active NPI Specialist · Brewster, WA
NPI 1790747954 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1790747954
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- MD00016562 (WA)
- Practice address
- 507 Hospital Way
Brewster, WA 98812-0507 - Phone
- (509) 689-2517
- Fax
- (509) 689-2086
- NPI assigned
- Apr 4, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00016562 | WA | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MD00016562 | WA | Yes |
Addresses
Primary practice location
507 Hospital Way
Brewster, WA 98812-0507
Mailing address
PO Box 577
Brewster, WA 98812-0577
Phone (509) 689-2517
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1349703 | Medicaid | WA |
Other providers in Brewster, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.