Active NPI
Anthony Eric Davis, PSY.D.
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1881964526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1211
- Practice address
- 1832 NE Broadway St
Portland, OR 97232-1992 - Phone
- (503) 830-4816
- NPI assigned
- Jan 11, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 434 | OR | |
| Clinical Psychologist | 103TC0700X | 1211 | OR | Primary |
Addresses
Primary practice location
1832 NE Broadway St
Portland, OR 97232-1992
Mailing address
1832 NE Broadway St
Portland, OR 97232-1992
Phone (503) 830-4816
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 434 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436313600000",
"number": "1881964526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1832 NE BROADWAY ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321992",
"telephone_number": "503-830-4816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1832 NE BROADWAY ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321992",
"telephone_number": "503-830-4816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "ANTHONY",
"middle_name": "ERIC",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-01-11",
"last_updated": "2015-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "434",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.