Healthcare Provider Details

I. General information

NPI: 1114331634
Provider Name (Legal Business Name): DIANNE SHERILL DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 12/06/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 RAINTREE CIR STE 120
ALLEN TX
75013-5024
US

IV. Provider business mailing address

8825 BEE CAVES RD STE 100
AUSTIN TX
78746-4721
US

V. Phone/Fax

Practice location:
  • Phone: 972-338-4528
  • Fax: 972-662-8279
Mailing address:
  • Phone: 512-328-3376
  • Fax: 512-666-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberS2974
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: