Active NPI
Wiley G Davis, M.D.
- Psychiatry Physician
- Lawton, OK
National Provider Identifier
1912910340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 12320
- Practice address
- 5002 SW Lee Boulevard
Lawton, OK 73505-8320 - Phone
- (580) 531-4512
- Fax
- (580) 531-4519
- NPI assigned
- Aug 15, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 12320 | OK | Primary |
Addresses
Primary practice location
5002 SW Lee Boulevard
Lawton, OK 73505-8320
Mailing address
5002 SW Lee Boulevard
Lawton, OK 73505-8320
Phone (580) 531-4512
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15560 | Other | OK | BNDD |
| 15560 | Other | OK | OBN |
| AD8776099 | Other | U.S. DEPT OF JUSTICE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1912910340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5002 SW LEE BOULEVARD",
"city": "LAWTON",
"state": "OK",
"postal_code": "735058320",
"telephone_number": "580-531-4512",
"fax_number": "580-531-4519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5002 SW LEE BOULEVARD",
"city": "LAWTON",
"state": "OK",
"postal_code": "735058320",
"telephone_number": "580-531-4512",
"fax_number": "580-531-4519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "WILEY",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-15",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "OK",
"license": "12320",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BNDD",
"identifier": "15560",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OBN",
"identifier": "15560",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U.S. DEPT OF JUSTICE",
"identifier": "AD8776099",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawton, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.