Individual
DEBRA ELLIOTT DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF NEUROLOGY, SHREVEPORT, LA 71103-4228
(318) 813-2482
(318) 813-2491
Mailing address
1501 KINGS HWY, DEPARTMENT OF NEUROLOGY, SHREVEPORT, LA 71103-4228
(318) 813-2482
(318) 813-2491
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
017921
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1378721
—
LA
01
—
54817F610
MEDICARE - PTAN
LA
Enumeration date
07/14/2006
Last updated
10/21/2011
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