Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | OS-007771-L | PA |
NPI | 1144473208 |
---|---|
Provider Name | Dr. Christopher Jackson Davis |
First Address | York, PA 17404-1752 |
Second Address | York, PA 17404-1752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2008 |
Last Update Date | 30/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0013950600010 | (05) | PA |