Organization
MADE LLC
Active
Organization
MADE LLC
Active
Other names
Lawrence A. Davis
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE DAVIS CSFA (CERT. SURG FIRST ASSIST)
(720) 363-3145
Entity
Organization
Contact information
Practice address
1882 E 104TH AVE UNIT 936, THORNTON, CO 80233-4336
(720) 363-3145
(720) 381-6313
Mailing address
1882 E 104TH AVE UNIT 936, THORNTON, CO 80233-4336
(720) 363-3145
(720) 381-6313
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1520
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010801006
COLORADO DRIVERS LICENSE
CO
Enumeration date
03/20/2013
Last updated
03/20/2013
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