Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD152128 | OR |
NPI | 1003025875 |
---|---|
Provider Name | Patrick Erin Davol |
First Address | Medford, OR 97504-5590 |
Second Address | Medford, OR 97504-5590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 14/12/2020 |