Provider Demographics
NPI:1740236017
Name:DAVIS, PAMELA NANCY ODELL (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:NANCY ODELL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:525 N SYCAMORE AVE
Mailing Address - Street 2:#318
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9001 WILSHIRE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1838
Practice Address - Country:US
Practice Address - Phone:310-624-1248
Practice Address - Fax:310-623-1257
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA79189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHP96011Medicare UPIN
CAA79189AMedicare ID - Type Unspecified