Provider Demographics
NPI:1740428358
Name:DAVIS, JUDITH M (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:1450 CREEKSIDE DR
Mailing Address - Street 2:#36
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5558
Mailing Address - Country:US
Mailing Address - Phone:925-705-5191
Mailing Address - Fax:
Practice Address - Street 1:1450 CREEKSIDE DR
Practice Address - Street 2:#36
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5558
Practice Address - Country:US
Practice Address - Phone:925-705-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG135832084P0800X
IL36-482642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D15418Medicare UPIN