| Doctor Name: | MR. JERRY WAYNE DAVIS |
| NPI Number: | 1356357495 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CRNA |
| License Number: | 565508 |
| Business Practice Address: | 2715 Avenue N Nederland, TX - 776277814 |
| Business Phone Number: | 4097299339 |
| Business Fax Number: | |
| Mailing Address: | 2715 Avenue N, NEDERLAND |
| State: | TX |
| Postal Code: | 776277814 |
| Phone Number: | 4097299339 |
| Fax Number: | |
| NPI Enumeration Date: | 07/31/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NC0060X |
| License Number: | 565508 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Critical Access |
| Taxonomy Definition: | |