Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 10683 | OK |
NPI | 1962601005 |
---|---|
Provider Name | Dr. Thomas Wayne Davis |
First Address | Oklahoma City, OK 73119-7024 |
Second Address | Oklahoma City, OK 73119-7024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2007 |
Last Update Date | 17/07/2007 |