Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 01070226A | IN |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 9900469 | NC |
N | 207YS0123X | Facial Plastic Surgeon | 01070226A | IN |
NPI | 1982631768 |
---|---|
Provider Name | Samuel P Davis III |
First Address | Morrisville, NC 27560-8442 |
Second Address | Goldsboro, NC 27534-9458 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 07/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040014729 | PALMETTO GBA-RR MEDICARE (01) | NC |
201036750 | (05) | IN |
891214V | (05) | NC |
G16831 | (02) |