Provider Demographics
NPI:1104688811
Name:DAVIS, MATISON MARIE (LM)
Entity type:Individual
Prefix:
First Name:MATISON
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 N WASHBURN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-2918
Mailing Address - Country:US
Mailing Address - Phone:940-255-3321
Mailing Address - Fax:940-220-9263
Practice Address - Street 1:903 N WASHBURN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-2918
Practice Address - Country:US
Practice Address - Phone:940-255-3321
Practice Address - Fax:940-220-9263
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99563176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife