Provider Demographics
NPI:1144411646
Name:DAVIS, REBECCA A (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3544
Mailing Address - Country:US
Mailing Address - Phone:903-593-7977
Mailing Address - Fax:903-593-7899
Practice Address - Street 1:2501 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3544
Practice Address - Country:US
Practice Address - Phone:903-593-7977
Practice Address - Fax:903-593-7899
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50630237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0085MEOtherBCBS
TX80374AOtherBCBS
TX80259AOtherBCBS
TX80374AOtherBCBS
TX80259AOtherBCBS