Provider Demographics
NPI:1023005444
Name:DAVIS, MARCIA JEANNE (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:JEANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4062 FLYING C RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9664
Mailing Address - Country:US
Mailing Address - Phone:530-676-8234
Mailing Address - Fax:530-676-0819
Practice Address - Street 1:4062 FLYING C RD
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-9664
Practice Address - Country:US
Practice Address - Phone:530-676-8234
Practice Address - Fax:530-676-0819
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG77530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G775300Medicaid
CABO7750892OtherDEA
CA00G775300Medicaid
CABO7750892OtherDEA