Healthcare Provider Details

I. General information

NPI: 1316048101
Provider Name (Legal Business Name): PAMELA F DAVIS, MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4622 PROGRESS DRIVE SUITE C
DAVENPORT IA
52807
US

IV. Provider business mailing address

4622 PROGRESS DRIVE SUITE C
DAVENPORT IA
52807
US

V. Phone/Fax

Practice location:
  • Phone: 563-355-2210
  • Fax:
Mailing address:
  • Phone: 563-355-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number29871
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1957696
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: PAMELA F DAVIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 563-355-2210