Provider Demographics
NPI:1013957349
Name:DAVIS, KAREN S (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
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 1:1076 PALOMINO RD
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-4311
Mailing Address - Country:US
Mailing Address - Phone:707-894-4188
Mailing Address - Fax:
Practice Address - Street 1:1076 PALOMINO RD
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425-4311
Practice Address - Country:US
Practice Address - Phone:707-894-4188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33607208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45609Medicare UPIN
A45609Medicare UPIN