Individual
CHARLES M DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8201 E RIVERSIDE BLVD, ROCKFORD, IL 61114-2300
(815) 971-7000
Mailing address
1770 IOWA AVE STE 280, RIVERSIDE, CA 92507-7401
(951) 786-0801
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
056888
SC
2085R0202X
Diagnostic Radiology Physician
MMD5688MD
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
056888
—
SC
Enumeration date
10/25/2005
Last updated
08/05/2025
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