Individual
KEITH E DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
113 S APPLE ST, SHOSHONE, ID 83352-5287
(208) 886-2224
(208) 886-2634
Mailing address
113 S. APPLE ST., PO BOX 609, SHOSHONE, ID 83352-0609
(208) 886-2224
(208) 886-2634
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M4888
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001801000
—
ID
01
—
133841
RHC
—
Enumeration date
04/27/2006
Last updated
11/15/2010
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