Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 12102 | AZ |
NPI | 1043302656 |
---|---|
Provider Name | Mr. Gordon Doyle Davis |
First Address | Phoenix, AZ 85013 |
Second Address | Phoenix, AZ 85013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D36740 | (02) |