Individual
DR. WAYNE L. DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 W BROADWAY ST, MISSOULA, MT 59802-4003
(406) 543-7271
Mailing address
3205 S RUSSELL ST, MISSOULA, MT 59801-8536
(406) 721-4906
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
7721
MT
2085R0202X
Diagnostic Radiology Physician
Primary
7721
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011466
—
MT
Enumeration date
06/01/2006
Last updated
01/24/2011
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