Provider Demographics
NPI:1972552461
Name:DAVIS, ALAN DEAN (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:DEAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 DOUGLAS AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5923
Mailing Address - Country:US
Mailing Address - Phone:214-369-6434
Mailing Address - Fax:214-696-6273
Practice Address - Street 1:6130 W PARKER RD
Practice Address - Street 2:#508
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7912
Practice Address - Country:US
Practice Address - Phone:972-981-8430
Practice Address - Fax:972-981-3242
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0392207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133017704Medicaid
TX133017705Medicaid
TX133017704Medicaid
TX88062BMedicare PIN