MEDICARE: DR. PAMELA D DAVIS D.O.

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	2001002804	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	706A949	OTHER		MEDICARE INDIVIDUAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28581041	OTHER		BCBS

General Provider Information

NPI Number	:	1336144930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA D DAVIS D.O.

Provider Business Mailing Address
First Line	:	1601 N HIGHWAY 7
Second Line	:
City	:	PLEASANT HILL
State	:	MO
Zip	:	64080-1945
Country	:	US
Telephone Number	:	816-540-2111
Fax Number	:	816-540-6065

Provider Business Practice Location Address
First Line	:	1601 N HIGHWAY 7
Second Line	:
City	:	PLEASANT HILL
State	:	MO
Zip	:	64080-1945
Country	:	US
Telephone Number	:	816-540-2111
Fax Number	:	816-540-6065

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	03/03/2008

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Directions to “ DR. PAMELA D DAVIS D.O.” Practice Location

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