| Doctor Name: | ELIJAH LORENZO DAVIS |
| NPI Number: | 1265545966 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M |
| License Number: | 1200374 |
| Business Practice Address: | 5202 Faraon St. Ste. A St. Joseph, MO - 645063480 |
| Business Phone Number: | 8162711067 |
| Business Fax Number: | 8162711071 |
| Mailing Address: | 5202 Faraon St., Ste. A ST. JOSEPH |
| State: | MO |
| Postal Code: | 645063480 |
| Phone Number: | 8162711067 |
| Fax Number: | 8162711071 |
| NPI Enumeration Date: | 08/16/2006 |
| NPI Last Update Date: | 09/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | 1200374 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KS |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |