Provider Demographics
NPI:1508907676
Name:DAVIS, ELISA A (MD)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 720006
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4006
Mailing Address - Country:US
Mailing Address - Phone:405-743-7300
Mailing Address - Fax:405-743-7256
Practice Address - Street 1:1201 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5476
Practice Address - Country:US
Practice Address - Phone:405-743-7300
Practice Address - Fax:405-743-7256
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25157207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine