Healthcare Provider Details

I. General information

NPI: 1538246152
Provider Name (Legal Business Name): DEBRA JEAN DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CONTINENTAL DR STE 401
NEWARK DE
19713-4337
US

IV. Provider business mailing address

200 CONTINENTAL DR STE 401
NEWARK DE
19713-4337
US

V. Phone/Fax

Practice location:
  • Phone: 509-570-3701
  • Fax:
Mailing address:
  • Phone: 509-570-3701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00045314
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number67111-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number8437
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code207VC0200X
TaxonomyCritical Care Medicine (Obstetrics & Gynecology) Physician
License Number8437
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code207VC0300X
TaxonomyComplex Family Planning Physician
License Number8437
License Number StateND
# 6
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number67111-20
License Number StateWI
# 7
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number8437
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: