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Individual
JEROME M. DAVIS
Active
Individual
JEROME M. DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
11391
SC
207LP2900X
Pain Medicine (Anesthesiology) Physician
11391
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113914
—
SC
01
—
C606001358
MEDICARE PTAN
SC
Enumeration date
03/23/2006
Last updated
06/20/2014
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