Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 25MA06127700 | NJ |
Y | 2080P0203X | Pediatric Critical Care Doctor | 266568 | NY |
NPI | 1033185327 |
---|---|
Provider Name | Dr. Alan Davis |
First Address | New York, NY 10087-7842 |
Second Address | Flushing, NY 11355-5045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 16/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E99121 | (02) | NJ |