Provider Demographics
NPI:1538246152
Name:DAVIS, DEBRA JEAN (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:JEAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CONTINENTAL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4337
Mailing Address - Country:US
Mailing Address - Phone:509-570-3701
Mailing Address - Fax:
Practice Address - Street 1:200 CONTINENTAL DR STE 401
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4337
Practice Address - Country:US
Practice Address - Phone:509-570-3701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045314207V00000X
WI67111-20207V00000X, 207VF0040X
ND8437207V00000X, 207VC0200X, 207VC0300X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VC0200XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyCritical Care Medicine
No207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family Planning
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH12825Medicare UPIN