Provider Demographics
NPI:1285648808
Name:DAVIS, LISA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
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 1:520 CAMDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1924
Mailing Address - Country:US
Mailing Address - Phone:210-223-3246
Mailing Address - Fax:210-223-1816
Practice Address - Street 1:520 CAMDEN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1924
Practice Address - Country:US
Practice Address - Phone:210-223-3246
Practice Address - Fax:210-223-1816
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0120OtherBLUE CROSS BLUE SHIELD
TX130317407Medicaid
TX110231083OtherRAILROAD MEDICARE PTAN
TX130317405Medicaid
TX8024B0Medicare PIN
TX130317405Medicaid
TX130317407Medicaid