1700923083 NPI number — DR. LISA ANNE DAVIS MD

Table of content: DR. LISA ANNE DAVIS MD (NPI 1700923083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700923083 NPI number — DR. LISA ANNE DAVIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
LISA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TANNER
Provider Other First Name:
LISA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700923083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 DELAWARE ST
Provider Second Line Business Practice Location Address:
MC0148
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80204-4532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-602-6191
Provider Business Practice Location Address Fax Number:
303-602-6190
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  46509 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34832572 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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