Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | G84892 | CA |
NPI | 1316959240 |
---|---|
Provider Name | Bret Davis |
First Address | Santa Barbara, CA 93160-2106 |
Second Address | Santa Barbara, CA 93110-1416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 23/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E87034 | (02) | CA |