Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | LA | |
N | 222Z00000X | Podiatrist | LA | |
N | 224P00000X | Prosthetist | LA | |
Y | 225000000X | Orthotic Fitter | LA |
NPI | 1174719033 |
---|---|
Provider Name | Mr. Charles Henry Davis |
First Address | Bossier, LA 71111-4859 |
Second Address | Bossier City, LA 71111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2007 |
Last Update Date | 27/10/2007 |