Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 28349 | OK |
NPI | 1013038371 |
---|---|
Provider Name | Dr. Jeremy Alex Davis |
First Address | Oklahoma City, OK 73196-0610 |
Second Address | Oklahoma City, OK 73120-8396 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 25/10/2021 |