Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 00302 | KY |
Y | 222Z00000X | Podiatrist | 00302 | KY |
N | 213ES0131X | Foot Surgery | 302 | KY |
NPI | 1326047119 |
---|---|
Provider Name | Dr. Kevin W Davis |
First Address | Springfield, TN 37172-1455 |
Second Address | Springfield, TN 37172-3963 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 10/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3353857 | (05) | TN |
3736461 | (05) | TN |
4179406 | BLUE CROSS BLUE SHIELD TENNESSEE (01) | |
80000565 | (05) | KY |
80900319 | (05) | KY |
90004391 | MEDICAID DME (01) | KY |
DF9516 | RAILROAD MEDICARE (01) | KY |
P00419400 | RAILROAD MEDICARE (01) | KY |