Provider Demographics
NPI:1760472419
Name:DAVIS, PAUL CORKRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CORKRAN
Last Name:DAVIS
Suffix:
Gender:M
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:PO BOX 51008
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-1008
Mailing Address - Country:US
Mailing Address - Phone:318-798-9400
Mailing Address - Fax:318-798-3894
Practice Address - Street 1:1453 E BERT KOUN LOOP STE 112
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-6810
Practice Address - Country:US
Practice Address - Phone:318-798-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.018467207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA060017099OtherRAILROAD MEDICARE
AR119005001Medicaid
LA1912883Medicaid
TX106834802Medicaid
AR119005001Medicaid
TX106834802Medicaid