Provider Demographics
NPI:1215987094
Name:DAVIS, PAULA JANE (MD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:JANE
Other - Last Name:SIEVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1301 SW ARBORWALK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4101
Mailing Address - Country:US
Mailing Address - Phone:816-537-6323
Mailing Address - Fax:
Practice Address - Street 1:1301 SW ARBORWALK BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4101
Practice Address - Country:US
Practice Address - Phone:816-537-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005021803207Q00000X
KS20697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100158720 GMedicaid
MO208633107Medicaid
KS100158720 GMedicaid
MOT536249Medicare PIN