Individual
DAVIS L BRONSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
355 CHARDONNAY AVE, PROSSER, WA 99350-9521
(509) 781-6366
Mailing address
PO BOX 719, SUNNYSIDE, WA 98944-0719
(509) 837-1617
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
2002029450
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100430470A
—
KS
01
—
166067
ANTHEM
MO
05
—
200000520A
—
OK
05
—
205970908
—
MO
01
—
240007925
RR MEDICARE
—
Enumeration date
06/22/2006
Last updated
03/06/2025
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