Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2020022988 | MO |
N | 1223G0001X | General Practice | 19572 | TX |
N | 213EG0000X | General Practice | 19572 | TX |
NPI | 1225057029 |
---|---|
Provider Name | Dr. John Rance Davis |
First Address | Cassville, MO 65625-9753 |
Second Address | Cassville, MO 65625-9753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 30/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19572 | STATE LICENSE (01) | TX |
2020022988 | STATE LICENSE (01) | MO |
752849726 | TAX ID (01) |