Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA69177 | FL |
NPI | 1184988347 |
---|---|
Provider Name | Ronald Thomas Davis |
First Address | Tampa, FL 33623-6798 |
Second Address | Tampa, FL 33629-8652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2012 |
Last Update Date | 02/07/2012 |