Provider Demographics
NPI:1801005970
Name:DAVIS, CAROLYN CUPPS (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:CUPPS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:CUPPS
Other - Last Name:LOBUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 2653
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95609-2653
Mailing Address - Country:US
Mailing Address - Phone:916-482-1345
Mailing Address - Fax:916-488-0284
Practice Address - Street 1:2864 EL PRADO WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1835
Practice Address - Country:US
Practice Address - Phone:916-482-1345
Practice Address - Fax:916-488-0284
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32758207V00000X
WAMD00017810207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology