Provider Demographics
NPI:1003862715
Name:DAVIS-HERR, JACQUELINE LETICIA (MD)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LETICIA
Last Name:DAVIS-HERR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4001 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1565
Mailing Address - Country:US
Mailing Address - Phone:972-420-1470
Mailing Address - Fax:972-420-1465
Practice Address - Street 1:4001 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1565
Practice Address - Country:US
Practice Address - Phone:972-420-1470
Practice Address - Fax:972-420-1465
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182734701Medicaid
TX182734701Medicaid
TX8G6778Medicare PIN