Provider Demographics
NPI:1508933748
Name:DAVIS, DEBRA STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:STEWART
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 UNIVERSITY BLVD E
Mailing Address - Street 2:SUITE 810
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2086
Mailing Address - Country:US
Mailing Address - Phone:205-366-0009
Mailing Address - Fax:205-366-0097
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 810
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2086
Practice Address - Country:US
Practice Address - Phone:205-366-0009
Practice Address - Fax:205-366-0097
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051526799Medicaid
ALP00219609OtherMEDICARE RAILROAD
AL051526799OtherBLUE CROSS/BLUE SHIELD OF ALABAMA
ALP00219609OtherMEDICARE RAILROAD
ALF85757Medicare UPIN