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1740609171 NPI number — DESIRAE PATRICE DAVIS MD

NPI Number: 1740609171
Health Care Provider/Practitioner: DESIRAE PATRICE DAVIS MD

Information about “1740609171” NPI (DESIRAE PATRICE DAVIS MD) exists in 1740609171 in HTML format HTML  |  1740609171 in plain Text format TXT  |  1740609171 in PDF (Portable Document Format) PDF  |  1740609171 in an XML format XML  formats.

NPI Number : 1740609171 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740609171",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAVIS",
    "FirstName": "DESIRAE",
    "MiddleName": "PATRICE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CHRISTIAN",
    "OtherFirstName": "DESIRAE",
    "OtherMiddleName": "PATRICE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2570 HAYMAKER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MONROEVILLE",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "15146-3513",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "412-858-2000",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2570 HAYMAKER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MONROEVILLE",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "15146-3513",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "412-858-2000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/14/2014",
    "LastUpdateDate": "11/01/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207LP2900X",
        "TaxonomyName": "Pain Medicine (Anesthesiology) Physician",
        "LicenseNumber": "MD466885",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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