Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 112049 | NY |
NPI | 1063451318 |
---|---|
Provider Name | Robert S. Davis |
First Address | Rochester, NY 14642-0001 |
Second Address | Rochester, NY 14642-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 28/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00454788 | (05) | NY |
D79111 | (02) | NY |