Provider Demographics
NPI:1871851527
Name:SANDRA DAVIS MD, PA
Entity Type:Organization
Organization Name:SANDRA DAVIS MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ECHEGOYEN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-888-5946
Mailing Address - Street 1:5724 EL CAMPO AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4646
Mailing Address - Country:US
Mailing Address - Phone:817-888-5946
Mailing Address - Fax:817-259-2785
Practice Address - Street 1:6777 CAMP BOWIE BLVD STE 229
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7157
Practice Address - Country:US
Practice Address - Phone:682-703-1311
Practice Address - Fax:817-259-2785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry