Provider Demographics
NPI:1457300717
Name:DAVIS, WALTER (EDD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 N MERIDIAN AVE
Mailing Address - Street 2:BLDG 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9369
Mailing Address - Country:US
Mailing Address - Phone:405-752-9500
Mailing Address - Fax:405-752-9571
Practice Address - Street 1:13301 N MERIDIAN AVE
Practice Address - Street 2:BLDG 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9369
Practice Address - Country:US
Practice Address - Phone:405-752-9500
Practice Address - Fax:405-752-9571
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK531103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7557018OtherAETNA
OK900000044001OtherBLUE CROSS/BLUE SHIELD
OK237278001A020OtherTRICARE