Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 40623 | KY |
N | 208200000X | Surgeon | 40623 | KY |
N | 208600000X | Surgeon | 40623 | KY |
NPI | 1154486744 |
---|---|
Provider Name | Eric G Davis |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40202-3905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 22/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200859990 | MEDICAID PASSPORT (01) | IN |
50014590 | MEDICAID PASSPORT (01) | KY |
64130503 | (05) | KY |
I73075 | (02) |