Healthcare Provider Details

I. General information

NPI: 1629153721
Provider Name (Legal Business Name): SUANNE M DAVES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 STANTON L YOUNG BLVD STE 1140
OKLAHOMA CITY OK
73104-5036
US

IV. Provider business mailing address

PO BOX 26901
OKLAHOMA CITY OK
73126-0901
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4351
  • Fax: 405-271-8695
Mailing address:
  • Phone: 405-271-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number32628
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number213428
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD44248
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMD44248
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-097240
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD44248
License Number StateTN
# 7
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number32628
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: