Doctor Name: | L BRENT DAVIS |
NPI Number: | 1366509416 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | PA120 |
Business Practice Address: | 801 N. Main Str. Faith Family Practice West Liberty, KY - 414721021 |
Business Phone Number: | 6067431422 |
Business Fax Number: | 6067431455 |
Mailing Address: | 801 Main St, WEST LIBERTY |
State: | KY |
Postal Code: | 414721021 |
Phone Number: | 6067431422 |
Fax Number: | |
NPI Enumeration Date: | 01/01/2007 |
NPI Last Update Date: | 09/08/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA120 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |