Provider Demographics
NPI:1538129739
Name:DAVIS, PATRICIA INGRID (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:INGRID
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1124 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-2010
Mailing Address - Country:US
Mailing Address - Phone:580-574-8008
Mailing Address - Fax:580-558-3324
Practice Address - Street 1:4301 WILSON ST
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-4472
Practice Address - Country:US
Practice Address - Phone:580-574-8008
Practice Address - Fax:580-558-3324
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine