Individual
LARRY J DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6901 MEDICAL PARKWAY, WACO, TX 76712
(254) 582-7481
(254) 582-2199
Mailing address
PO BOX 674047, DALLAS, TX 75267
(254) 582-7481
(254) 582-2199
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
C15087
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102739301
—
TX
05
—
102739304
—
TX
01
—
8X5373
BLUE CROSS BLUE SHIELD
TX
Enumeration date
02/27/2006
Last updated
05/29/2008
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