Provider Demographics
NPI:1164534863
Name:DAVIS, RENEE MARIE (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 E JANICE WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2514
Mailing Address - Country:US
Mailing Address - Phone:480-797-0455
Mailing Address - Fax:888-378-7475
Practice Address - Street 1:6201 E JANICE WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2514
Practice Address - Country:US
Practice Address - Phone:480-797-0455
Practice Address - Fax:888-378-7475
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11437207Q00000X
AZ1810207Q00000X
MI5101007556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64087919Medicaid
KY0693041Medicare PIN
KY64087919Medicaid