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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