Organization
ROGER W. DAVIS, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER W DAVIS (OWNER)
(719) 543-9202
Entity
Organization
Contact information
Practice address
511 W 29TH ST, SUITE B, PUEBLO, CO 81008-1128
(719) 543-9202
(719) 543-9204
Mailing address
511 W 29TH ST, SUITE B, PUEBLO, CO 81008-1128
(719) 543-9202
(719) 543-9204
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
30919
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38529343
—
CO
Enumeration date
08/12/2008
Last updated
08/12/2008
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