Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 145320 | NY |
N | 208D00000X | General Practice Physician | 145320 | NY |
NPI | 1568484780 |
---|---|
Provider Name | Christopher John Davis |
First Address | Rochester, NY 14618-1704 |
Second Address | Rochester, NY 14618-1704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 05/06/2020 |