MEDICARE: MARCIA JEANNE DAVIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G77530	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023005444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA JEANNE DAVIS M.D.

Provider Business Mailing Address
First Line	:	4062 FLYING C RD
Second Line	:
City	:	CAMERON PARK
State	:	CA
Zip	:	95682-9664
Country	:	US
Telephone Number	:	530-676-8234
Fax Number	:	530-676-0819

Provider Business Practice Location Address
First Line	:	4062 FLYING C RD
Second Line	:
City	:	CAMERON PARK
State	:	CA
Zip	:	95682-9664
Country	:	US
Telephone Number	:	530-676-8234
Fax Number	:	530-676-0819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	03/07/2023

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