Provider Demographics
NPI:1851311245
Name:DAVIS, DENISE LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LYNNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3031 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2051
Mailing Address - Country:US
Mailing Address - Phone:510-883-1046
Mailing Address - Fax:510-883-1746
Practice Address - Street 1:3031 TELEGRAPH AVE
Practice Address - Street 2:SUITE 217
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2051
Practice Address - Country:US
Practice Address - Phone:510-883-1046
Practice Address - Fax:510-883-1746
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG057866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG57866Medicaid
CAG57866Medicaid
CA00G578660Medicare ID - Type Unspecified