Individual
GEORGE BERTON DAVIS II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
133 PARK STREET, MALONE, NY 12953-0729
(518) 483-3000
(518) 481-2818
Mailing address
PO BOX 148, 49 SECOND STREET, MALONE, NY 12953-0148
(518) 483-2171
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
085787
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00354114
—
NY
Enumeration date
07/31/2008
Last updated
07/31/2008
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