Provider Demographics
NPI:1780659201
Name:DAVIS, CHRISTINE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2525 W BERYL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-1606
Mailing Address - Country:US
Mailing Address - Phone:602-467-4757
Mailing Address - Fax:602-371-4960
Practice Address - Street 1:8335 NAAB RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1919
Practice Address - Country:US
Practice Address - Phone:317-338-9000
Practice Address - Fax:317-338-9087
Is Sole Proprietor?:No
Enumeration Date:2006-02-19
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ108643Medicare PIN
AZH45548Medicare UPIN