Individual
DR. KENNETH DAVIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
234 GOODMAN STREET, CINCINNATI, OH 45219-2364
(513) 475-8787
(513) 558-3136
Mailing address
PO BOX 636256 CENTRAL CREDENTIALING, CINCINNATI, OH 45263-6256
(513) 585-5506
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
35 051087
OH
2086S0102X
Surgical Critical Care Physician
Primary
35-051087
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0571804
—
OH
05
—
64786429
—
KY
01
—
P00442454
RAILROAD MEDICARE
—
Enumeration date
03/08/2006
Last updated
03/09/2018
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