Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD00024408 | WA |
NPI | 1003843269 |
---|---|
Provider Name | Dr. Ronald Eugene Davis |
First Address | Federal Way, WA 98003-6328 |
Second Address | Pasco, WA 99301-5257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 11/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A06158 | (02) | WA |