Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 8677 | TX |
NPI | 1457427031 |
---|---|
Provider Name | Dr. John W Davis |
First Address | Kerrville, TX 78028-5809 |
Second Address | Kerrville, TX 78028-5809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 20/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8X5520 | BLUE CROSS BLUE SHIELD (01) |