MEDICARE: DR. LISA ANNE DAVIS MD

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	207RR0500X	Rheumatology Physician	46509	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700923083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA ANNE DAVIS MD

Provider Business Mailing Address
First Line	:	777 BANNOCK ST
Second Line	:	MC 4000
City	:	DENVER
State	:	CO
Zip	:	80204-4507
Country	:	US
Telephone Number	:	303-602-5012
Fax Number	:	303-602-5055

Provider Business Practice Location Address
First Line	:	700 DELAWARE ST
Second Line	:	MC0148
City	:	DENVER
State	:	CO
Zip	:	80204-4532
Country	:	US
Telephone Number	:	303-602-6191
Fax Number	:	303-602-6190

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	04/05/2021

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