Individual
DR. THEODORE EDWIN CLYDE DAVIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2603 KENTUCKY AVE, STE 404, PADUCAH, KY 42003-3814
(270) 443-6472
(270) 442-1649
Mailing address
2603 KENTUCKY AVE, STE 404, PADUCAH, KY 42003-3814
(270) 443-6472
(270) 442-1649
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
16229
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64162290
—
KY
01
—
P00391203
RAILROAD MEDICARE
KY
Enumeration date
06/01/2005
Last updated
05/07/2008
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