Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0131X | Foot Surgery | 1200374 | KS |
Y | 213ES0131X | Foot Surgery | 2208014928 | MO |
N | 213ES0131X | Foot Surgery | 316 | NE |
NPI | 1265545966 |
---|---|
Provider Name | Elijah Lorenzo Davis |
First Address | St. Joseph, MO 64506-3480 |
Second Address | St. Joseph, MO 64506-3480 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 11/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10026125400 | (05) | NE |
1265545966 | (05) | IA |
1265545966 | (05) | MO |
200575140A | (05) | KS |