Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 63020 | TN |
N | 207L00000X | Anesthesiologist | 66336 | WI |
N | 208D00000X | General Practice Physician | 66336-20 | WI |
NPI | 1033503412 |
---|---|
Provider Name | Dr. Ryan Davidovich |
First Address | Nashville, TN 37203-1458 |
Second Address | Nashville, TN 37203-1458 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033503412 | (05) | WI |