Provider Demographics
NPI:1487841433
Name:DAVIS, TENERIC JOSEPH (LSA)
Entity Type:Individual
Prefix:MR
First Name:TENERIC
Middle Name:JOSEPH
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10910 REDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3280
Mailing Address - Country:US
Mailing Address - Phone:713-271-2384
Mailing Address - Fax:281-833-8950
Practice Address - Street 1:10910 REDSTONE CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3280
Practice Address - Country:US
Practice Address - Phone:713-271-2384
Practice Address - Fax:281-833-8950
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00345246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant