Provider Demographics
NPI:1700923083
Name:DAVIS, LISA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:MC 4000
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:303-602-5012
Mailing Address - Fax:303-602-5055
Practice Address - Street 1:700 DELAWARE ST
Practice Address - Street 2:MC0148
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4532
Practice Address - Country:US
Practice Address - Phone:303-602-6191
Practice Address - Fax:303-602-6190
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46509207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34832572Medicaid
COCOAAA0765Medicare PIN