Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | J7773 | TX |
NPI | 1972590644 |
---|---|
Provider Name | Dr. Kent Gregory Davis |
First Address | Houston, TX 77064-1240 |
Second Address | Houston, TX 77054-2952 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2005 |
Last Update Date | 09/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165024401 | (05) | TX |
705550 | BEECHSTREET (01) | TX |
G73660 | (02) | TX |