Provider Demographics
NPI:1245207802
Name:DAVIS, PAMELA F (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:F
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4622 PROGRESS DRIVE
Mailing Address - Street 2:STE C
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807
Mailing Address - Country:US
Mailing Address - Phone:563-355-2210
Mailing Address - Fax:563-355-0199
Practice Address - Street 1:4622 PROGRESS DRIVE
Practice Address - Street 2:STE C
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807
Practice Address - Country:US
Practice Address - Phone:563-355-2210
Practice Address - Fax:563-355-0199
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29871207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15947Medicare ID - Type Unspecified
E34442Medicare UPIN