MEDICARE: TAMARA ELIZABETH DAVIS

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	374700000X	Technician

General Provider Information

NPI Number	:	1730988213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA ELIZABETH DAVIS

Provider Business Mailing Address
First Line	:	1706 WASHINGTON AVE APT 817
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1761
Country	:	US
Telephone Number	:	240-350-6342
Fax Number	:

Provider Business Practice Location Address
First Line	:	1253 S KIRKWOOD RD
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-7224
Country	:	US
Telephone Number	:	314-821-5300
Fax Number	:

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

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	03/10/2025

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Directions to “ TAMARA ELIZABETH DAVIS ” Practice Location

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