Provider Demographics
NPI:1063725356
Name:DAVIS HEALTH PA
Entity type:Organization
Organization Name:DAVIS HEALTH PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-377-2447
Mailing Address - Street 1:2831 ELDORADO PKWY
Mailing Address - Street 2:SUITE 103-303
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7438
Mailing Address - Country:US
Mailing Address - Phone:940-488-5046
Mailing Address - Fax:
Practice Address - Street 1:2831 ELDORADO PKWY
Practice Address - Street 2:SUITE 103-303
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7438
Practice Address - Country:US
Practice Address - Phone:940-488-5046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9213207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty