Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 29037 | OK |
NPI | 1689876435 |
---|---|
Provider Name | Dr. Joel Mark Davis |
First Address | Edmond, OK 73083-2378 |
Second Address | Edmond, OK 73013-3023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 26/10/2021 |