Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 16339 | MS |
NPI | 1083660732 |
---|---|
Provider Name | Dr. John D Davis IV |
First Address | Flowood, MS 39232 |
Second Address | Flowood, MS 39232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 07/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00126895 | (05) | MS |
140007830 | RAILROAD MEDICARE (01) | MS |
5385608 | AETNA (01) | MS |
630027 | UHC (01) | MS |
G78198 | (02) | MS |