Provider Demographics
NPI:1871617993
Name:DAVIS, ALLISON K (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 BOWLES AVENUE
Mailing Address - Street 2:SUITE 425
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026
Mailing Address - Country:US
Mailing Address - Phone:636-496-5080
Mailing Address - Fax:636-496-5095
Practice Address - Street 1:1011 BOWLES AVENUE
Practice Address - Street 2:SUITE 425
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026
Practice Address - Country:US
Practice Address - Phone:636-496-5080
Practice Address - Fax:636-496-5095
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL1436390200000X
OK27401208600000X
MO2017020376208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLL1436OtherMEDICAL LICENSE
OK27401OtherMEDICAL LICENSE
MO200045083Medicaid
MO200045083Medicaid