Individual
DR. CHARLES ISAAC DAVIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1615 PARKER AVE, OSAWATOMIE, KS 66064-1703
(913) 660-1616
Mailing address
36123 SCHOOLCRAFT RD, LIVONIA, MI 48150-1216
(913) 660-1616
(913) 660-1664
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
0429493
KS
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
2006018665
MO
Other
Enumeration date
01/04/2006
Last updated
04/06/2018
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