Provider Demographics
NPI:1922114685
Name:DAVIS, JUDY JEAN (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:JEAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 E PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9242
Mailing Address - Country:US
Mailing Address - Phone:559-298-6089
Mailing Address - Fax:559-298-6403
Practice Address - Street 1:7405 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2457
Practice Address - Country:US
Practice Address - Phone:559-438-8400
Practice Address - Fax:550-438-0477
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG460302080P0206X
ORMD2157562080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G460300Medicare ID - Type Unspecified
CAE50790Medicare UPIN