Active NPI
Rene Davila, MD
- Gastroenterology Physician
- Jackson, MS
National Provider Identifier
1831155308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 20542
- Practice address
- 2500 North State Street
Dept of Medicine Division of Digestive Disease
Jackson, MS 39216-4505 - Phone
- (601) 984-4540
- Fax
- (601) 984-4548
- NPI assigned
- Apr 25, 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 31854 | TN | |
| Gastroenterology Physician | 207RG0100X | 31854 | TN | |
| Gastroenterology Physician | 207RG0100X | 20542 | MS | Primary |
| Hepatology Physician | 207RI0008X | 31854 | TN |
Addresses
Primary practice location
2500 North State Street
Dept of Medicine Division of Digestive Disease
Jackson, MS 39216-4505
Mailing address
P.O. Box 24146
University Physicians, PLLC
Jackson, MS 39225-4146
Phone (601) 984-4540
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00121826 | Medicaid | MS | |
| 3845260 | Medicaid | TN |
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 |
|---|---|---|---|
| 31854 | TN | MD | Internal Medicine Physician |
| 20542 | MS | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341273600000",
"number": "1831155308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 24146",
"address_2": "UNIVERSITY PHYSICIANS, PLLC",
"city": "JACKSON",
"state": "MS",
"postal_code": "392254146",
"telephone_number": "601-984-4540",
"fax_number": "601-984-4548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 NORTH STATE STREET",
"address_2": "DEPT OF MEDICINE DIVISION OF DIGESTIVE DISEASE",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164505",
"telephone_number": "601-984-4540",
"fax_number": "601-984-4548"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVILA",
"first_name": "RENE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-25",
"last_updated": "2012-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "TN",
"license": "31854",
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "TN",
"license": "31854",
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "MS",
"license": "20542",
"primary": true
},
{
"code": "207RI0008X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hepatology",
"state": "TN",
"license": "31854",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00121826",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3845260",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.