Provider Demographics
NPI:1053421586
Name:DAVIS, JOSEPH LESLIE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LESLIE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 7TH AVE
Mailing Address - Street 2:C/O KAISER PERMANENTE
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3166
Mailing Address - Country:US
Mailing Address - Phone:360-425-8365
Mailing Address - Fax:
Practice Address - Street 1:2807 36TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-5309
Practice Address - Country:US
Practice Address - Phone:360-425-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00019590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine