Provider Demographics
NPI:1962710780
Name:DAVIS, DEMETRICE SHARNAE (MD)
Entity type:Individual
Prefix:
First Name:DEMETRICE
Middle Name:SHARNAE
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 1:3186 S MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2317
Mailing Address - Country:US
Mailing Address - Phone:702-942-4123
Mailing Address - Fax:
Practice Address - Street 1:7130 SMOKE RANCH RD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3157
Practice Address - Country:US
Practice Address - Phone:702-942-4117
Practice Address - Fax:864-987-1611
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA926882085R0202X
ARE-164152085R0202X
NV144152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1962710780Medicaid
NVP00113844OtherRR MEDICARE