MEDICARE: DR. AMY KATHLEEN DAVIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD108105	MO

General Provider Information

NPI Number	:	1245453844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY KATHLEEN DAVIS M.D.

Provider Business Mailing Address
First Line	:	1008 ROCK CREEK ELEMENTARY SCHOOL DR
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-7576
Country	:	US
Telephone Number	:	636-281-4410
Fax Number	:	636-281-4412

Provider Business Practice Location Address
First Line	:	1008 ROCK CREEK ELEMENTARY SCHOOL DR
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-7576
Country	:	US
Telephone Number	:	636-281-4410
Fax Number	:	636-281-4412

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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