Provider Demographics
NPI:1376734368
Name:DAVIS, ELLEN JEAN (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:JEAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2715 SW WILLETTA
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321
Mailing Address - Country:US
Mailing Address - Phone:541-926-2873
Mailing Address - Fax:541-926-2873
Practice Address - Street 1:2715 SW WILLETTA
Practice Address - Street 2:SUITE B
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321
Practice Address - Country:US
Practice Address - Phone:541-926-2873
Practice Address - Fax:541-926-2873
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2011-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORLL16985207R00000X
OR154086207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine