Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 94-10227 | KS |
NPI | 1013477942 |
---|---|
Provider Name | Tyler Davis |
First Address | Kansas City, KS 66160-0001 |
Second Address | Kansas City, KS 66160-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2019 |
Last Update Date | 14/07/2020 |