Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 20797 | MS |
Y | 2084N0402X | Child Neurologist | 307056 | LA |
NPI | 1003006206 |
---|---|
Provider Name | Lamar Davis II |
First Address | Jackson, MS 39216-4505 |
Second Address | Jackson, MS 39216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 23/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03122859 | (05) | MS |