Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | D0024332 | MD |
NPI | 1215956529 |
---|---|
Provider Name | Dr. Randy Frank Davis |
First Address | Stafford, VA 22554-1615 |
Second Address | Baltimore, MD 21224-5251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 12/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D70352 | (02) | MD |