Provider Demographics
NPI:1053308569
Name:SHIRLEY - DAVIS, DIANE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:SHIRLEY - DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:SHIRLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10740 N GESSNER DR
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:13325 HARGRAVE RD
Practice Address - Street 2:STE 270
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4350
Practice Address - Country:US
Practice Address - Phone:832-237-2227
Practice Address - Fax:832-237-3930
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1746207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1101599OtherBEECHSTREET
TX142009301Medicaid
TX040015859Medicare PIN
TXH32704Medicare UPIN
TX1101599OtherBEECHSTREET