Provider Demographics
NPI:1780690271
Name:DAVIS, NINA SARAH (MD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:SARAH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Mailing Address - Street 2:P3-GU
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2964
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:503-220-3415
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:KPV - 7C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-418-4562
Practice Address - Fax:503-418-4602
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD22752208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287684Medicaid
F21978Medicare UPIN