Provider Demographics
NPI:1437303724
Name:DAVIS, SHIRLEY DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:DIANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9040A FITZSIMMONS AVE
Mailing Address - Street 2:BLDG 9913A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-1332
Mailing Address - Fax:
Practice Address - Street 1:9040A FITZSIMMONS AVE
Practice Address - Street 2:BLDG 9913A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32442202C00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine