Provider Demographics
NPI:1699781997
Name:DAVIS, JAN KATHRYN (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:KATHRYN
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 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 327
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-932-0045
Mailing Address - Fax:713-932-7245
Practice Address - Street 1:909 FROSTWOOD DR
Practice Address - Street 2:SUITE 327
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2301
Practice Address - Country:US
Practice Address - Phone:713-932-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3887208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12-80108OtherUNITED
TX4411938OtherAETNA PPO
TX890136OtherBLUE CROSS/ BLUE SHIELD
TX2007932OtherAETNA HMO
TXF99541Medicare UPIN