Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35075818 | OH |
NPI | 1003857749 |
---|---|
Provider Name | Labronz C Davis |
First Address | Columbus, OH 43204-2645 |
Second Address | Columbus, OH 43204-2645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 18/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2138154 | (05) | OH |