Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 30501 | AZ |
Y | 207QS0010X | Family Doctor - Sports Medicine | 35.120017 | OH |
NPI | 1063414480 |
---|---|
Provider Name | Dr. Jeffrey Todd Davis |
First Address | Westerville, OH 43081-8970 |
Second Address | Westerville, OH 43081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 30/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0249379 | (05) | OH |
926876 | (05) | AZ |
I28007 | (02) | AZ |