Provider Demographics
NPI:1134785629
Name:DAVIS, ELIZABETH IRENE (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:IRENE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 650859 DEPT 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0570
Mailing Address - Country:US
Mailing Address - Phone:409-772-0620
Mailing Address - Fax:409-772-5462
Practice Address - Street 1:400 HARBORSIDE DR
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-5302
Practice Address - Country:US
Practice Address - Phone:409-747-1883
Practice Address - Fax:409-727-8579
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXT6544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine