Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 34.009667 | OH |
N | 207VE0102X | Reproductive Endocrinologist | 255869 | NY |
Y | 207VE0102X | Reproductive Endocrinologist | 60890 | WI |
NPI | 1578754875 |
---|---|
Provider Name | Dr. Joseph Bartlett Davis |
First Address | Menomonee Falls, WI 53051-0538 |
Second Address | Menomonee Falls, WI 53051-0538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 05/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
255869 | NEW YORK STATE MEDICAL LICENSE (01) | NY |
34.009667 | STATE OF OHIO (01) | OH |
60890-21 | WISCONSIN STATE MEDICAL BOARD (01) | WI |