Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 35-06-5167-D | OH |
Y | 208600000X | Surgeon | 35-06-5167-D | OH |
NPI | 1013008127 |
---|---|
Provider Name | Dr. Lisa A Davis |
First Address | Chardon, OH 44024-8702 |
Second Address | Willoughby, OH 44094-4456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000127718 | ANTHEM (01) | OH |
1300195 | UNITED HEALTH CARE (01) | OH |
2027943 | (05) | OH |
5143509 | AETNA (01) | OH |
80616 | QUAL CHOICE (01) | OH |
G56149 | (02) | OH |