Provider Demographics
NPI:1548584410
Name:DAVIS, TERAN MILLS (DO)
Entity Type:Individual
Prefix:DR
First Name:TERAN
Middle Name:MILLS
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 MYERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-7513
Mailing Address - Country:US
Mailing Address - Phone:918-549-8284
Mailing Address - Fax:
Practice Address - Street 1:12222 N CENTRAL EXPY
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3720
Practice Address - Country:US
Practice Address - Phone:214-219-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0192207L00000X
OK4512207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289646601Medicaid
TX289646601Medicaid