Provider Demographics
NPI:1679536940
Name:DAVIS, ALEXANDER C (MD)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:C
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 1:12140 NALL AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2503
Mailing Address - Country:US
Mailing Address - Phone:913-948-6400
Mailing Address - Fax:913-948-6499
Practice Address - Street 1:12140 NALL AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2503
Practice Address - Country:US
Practice Address - Phone:913-948-6400
Practice Address - Fax:913-948-6499
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0418232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110141836OtherRAILROAD MEDICARE
MO09414045OtherBC
C52273Medicare UPIN
110141836OtherRAILROAD MEDICARE