Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | R9C30 | MO |
N | 207U00000X | Nuclear Medicine Specialist | R9C30 | MO |
NPI | 1235173675 |
---|---|
Provider Name | Dr. Victor G Davila |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Creve Coeur, MO 63141-6399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202690111 | (05) | MO |