Individual
MARK L. DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
3315 KETHLEY RD, SHAWNEE, OK 74804-9638
(405) 273-5801
(405) 878-3814
Mailing address
PO BOX 849, SHAWNEE, OK 74802-0849
(405) 273-5801
(495) 878-3814
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA801
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100715900B
—
OK
Enumeration date
09/30/2006
Last updated
08/29/2012
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