Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 002424 | NY |
Y | 222Z00000X | Podiatrist | 002424 | NY |
N | 213E00000X | Podiatrist | 634 | FL |
N | 222Z00000X | Podiatrist | 634 | FL |
NPI | 1063403673 |
---|---|
Provider Name | Julian Scott Davis |
First Address | Franklin Square, NY 11010-2635 |
Second Address | Franklin Square, NY 11010-2635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00401405 | (05) | NY |
340499400 | (05) | FL |
T50765 | (02) |