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Individual
BJ DAVIS
Active
Individual
BJ DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A40958
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2300559
MEDICARE PTAN
—
05
—
41723
—
NM
Enumeration date
12/07/2007
Last updated
12/07/2007
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