Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 01048628 | IN |
NPI | 1154468270 |
---|---|
Provider Name | Mr. Daniel H Davis |
First Address | Chicago, IL 60677-5383 |
Second Address | Columbus, IN 47203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 28/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000984492 | ANTHEM PIN (01) | IN |
200188600A | (05) | IN |
G73858 | (02) | IN |