MEDICARE: PAULA JANE DAVIS MD

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	2005021803	MO
2	207Q00000X	Family Medicine Physician	20697	KS

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215987094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA JANE DAVIS MD

Provider Business Mailing Address
First Line	:	1301 SW ARBORWALK BLVD
Second Line	:	SUITE A
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4101
Country	:	US
Telephone Number	:	816-537-6323
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 SW ARBORWALK BLVD
Second Line	:	SUITE A
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4101
Country	:	US
Telephone Number	:	816-537-6323
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/29/2009

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Directions to “ PAULA JANE DAVIS MD” Practice Location

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