Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G33607 | CA |
NPI | 1013957349 |
---|---|
Provider Name | Karen S Davis |
First Address | Cloverdale, CA 95425-4311 |
Second Address | Cloverdale, CA 95425-4311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 03/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A45609 | (02) | |
A45609 | (02) | CA |