Active NPI
Craig Matthew Davis, M.D.
- Dermatopathology Physician
- Las Vegas, NV
National Provider Identifier
1972611556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatopathology Physician
- License
- 10713
- Practice address
- 8440 W Lake Mead Blvd
Suite 104
Las Vegas, NV 89128-7648 - Phone
- (702) 489-4838
- Fax
- (702) 489-4837
- NPI assigned
- Aug 25, 2006
- 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 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatopathology (Pathology) Physician | 207ZD0900X | 23337 | OK | |
| Dermatology Physician | 207N00000X | 23337 | OK | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 4820 | OK | |
| Dermatopathology (Pathology) Physician | 207ZD0900X | 10713 | NV | |
| Dermatopathology Physician | 207ND0900X | 10713 | NV | Primary |
| MOHS-Micrographic Surgery Physician | 207ND0101X | 10713 | NV | |
| Procedural Dermatology Physician | 207NS0135X | 10713 | NV | |
| Dermatology Physician | 207N00000X | 10713 | NV | |
| Anatomic Pathology Physician | 207ZP0101X | 10713 | NV | |
| Dermatology Physician | 207N00000X | 31661 | AZ | |
| Dermatopathology Physician | 207ND0900X | 31661 | AZ | |
| Dermatopathology (Pathology) Physician | 207ZD0900X | 31661 | AZ | |
| Anatomic Pathology Physician | 207ZP0101X | 31661 | AZ | |
| MOHS-Micrographic Surgery Physician | 207ND0101X | 31661 | AZ | |
| General Practice Physician | 208D00000X | 10713 | NV |
Addresses
Primary practice location
8440 W Lake Mead Blvd
Suite 104
Las Vegas, NV 89128-7648
Mailing address
8440 W Lake Mead Blvd
Suite 104
Las Vegas, NV 89128-7648
Phone (702) 489-4838
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 |
|---|---|---|---|
| 4820 | OK | MD | Neuromusculoskeletal Medicine & OMM Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468972800000",
"number": "1972611556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8440 W LAKE MEAD BLVD",
"address_2": "SUITE 104",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891287648",
"telephone_number": "702-489-4838",
"fax_number": "702-489-4837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8440 W LAKE MEAD BLVD",
"address_2": "SUITE 104",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891287648",
"telephone_number": "702-489-4838",
"fax_number": "702-489-4837"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "CRAIG",
"middle_name": "MATTHEW",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-25",
"last_updated": "2016-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "207ZD0900X",
"taxonomy_group": "",
"desc": "Pathology, Dermatopathology",
"state": "OK",
"license": "23337",
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "OK",
"license": "23337",
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "OK",
"license": "4820",
"primary": false
},
{
"code": "207ZD0900X",
"taxonomy_group": "",
"desc": "Pathology, Dermatopathology",
"state": "NV",
"license": "10713",
"primary": false
},
{
"code": "207ND0900X",
"taxonomy_group": "",
"desc": "Dermatology, Dermatopathology",
"state": "NV",
"license": "10713",
"primary": true
},
{
"code": "207ND0101X",
"taxonomy_group": "",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": "NV",
"license": "10713",
"primary": false
},
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "NV",
"license": "10713",
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NV",
"license": "10713",
"primary": false
},
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "NV",
"license": "10713",
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "AZ",
"license": "31661",
"primary": false
},
{
"code": "207ND0900X",
"taxonomy_group": "",
"desc": "Dermatology, Dermatopathology",
"state": "AZ",
"license": "31661",
"primary": false
},
{
"code": "207ZD0900X",
"taxonomy_group": "",
"desc": "Pathology, Dermatopathology",
"state": "AZ",
"license": "31661",
"primary": false
},
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "AZ",
"license": "31661",
"primary": false
},
{
"code": "207ND0101X",
"taxonomy_group": "",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": "AZ",
"license": "31661",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "NV",
"license": "10713",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.