Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 10503 | MT |
N | 208600000X | Surgeon | 10503 | MT |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | N1301 | TX |
NPI | 1003858127 |
---|---|
Provider Name | John Davis |
First Address | The Woodlands, TX 77380-2388 |
Second Address | Houston, TX 77002-8231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 27/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202055401 | (05) | TX |