Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 20041255A | IN |
N | 103TC0700X | Clinical Psychologist | 20041255A | IN |
N | 103TH0100X | Health Service | 20041255A | IN |
NPI | 1124157995 |
---|---|
Provider Name | Dr. Edgar Davis |
First Address | Indianapolis, IN 46205-1822 |
Second Address | Indianapolis, IN 46205-1822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |