Provider Demographics
NPI:1467600536
Name:DR. PARTICIA L DAVIS M.D.
Entity Type:Organization
Organization Name:DR. PARTICIA L DAVIS M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARTICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:575-623-9330
Mailing Address - Street 1:1206 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-2010
Mailing Address - Country:US
Mailing Address - Phone:575-623-9330
Mailing Address - Fax:575-623-5651
Practice Address - Street 1:1206 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-2010
Practice Address - Country:US
Practice Address - Phone:575-623-9330
Practice Address - Fax:575-623-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2907Medicaid
NMD43100Medicare UPIN
NM2130343Medicare PIN