Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 78317 | MA |
Y | 2084N0402X | Child Neurologist | ME81662 | FL |
NPI | 1396792024 |
---|---|
Provider Name | Ronald G Davis |
First Address | Winter Park, FL 32789-4878 |
Second Address | Orlando, FL 32819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 05/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
262510500 | (05) | FL |
H00963 | (02) | FL |