Healthcare Provider Details

I. General information

NPI: 1265485957
Provider Name (Legal Business Name): DEBORAH SUSAN DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH S. WOOSLEY

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15512 W 113TH ST
LENEXA KS
66219-5100
US

IV. Provider business mailing address

15512 W 113TH ST
LENEXA KS
66219-5100
US

V. Phone/Fax

Practice location:
  • Phone: 913-317-7990
  • Fax: 913-317-7018
Mailing address:
  • Phone: 913-317-7990
  • Fax: 816-922-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0428412
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: