Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A131032 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | A131032 | CA |
NPI | 1013232537 |
---|---|
Provider Name | Dr. Jeremy Cameron Davis |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Beverly Hills, CA 90211-2919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2010 |
Last Update Date | 28/08/2019 |