Provider Demographics
NPI:1568472785
Name:DAVIS, CARLA ELAINE (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ELAINE
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 1:315 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4050
Mailing Address - Country:US
Mailing Address - Phone:406-880-4831
Mailing Address - Fax:
Practice Address - Street 1:3075 N RESERVE ST
Practice Address - Street 2:SUITE Q
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1389
Practice Address - Country:US
Practice Address - Phone:406-327-1850
Practice Address - Fax:406-327-1875
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT7595207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000007801OtherBCBS
MT0104286Medicaid
F90654Medicare UPIN
MT0104286Medicaid