Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 35-054701 | OH |
NPI | 1912098088 |
---|---|
Provider Name | Ira D Davis |
First Address | Shaker Hts, OH 44122-5203 |
Second Address | Cleveland, OH 44106-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000028300 | ANTHEM (01) | OH |
0795591 | (05) | OH |
37000191 | RAILROAD MEDICARE (01) | OH |
F08526 | (02) | OH |