Provider Demographics
NPI:1720146467
Name:DAVIS, KAYE E (MD)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:E
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 1:2326 STUTZ DR UNIT 116
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6540
Mailing Address - Country:US
Mailing Address - Phone:773-368-8845
Mailing Address - Fax:
Practice Address - Street 1:3998 FAIR RIDGE DR
Practice Address - Street 2:STE 320
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2907
Practice Address - Country:US
Practice Address - Phone:703-295-9360
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256976207L00000X
TXT0191207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089197Medicaid
ILP00154997OtherRAILROAD MEDICARE
IL04932277OtherBCBS
ILP00154997OtherRAILROAD MEDICARE
ILK07754Medicare PIN