Individual
PAUL J DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
ONE MEDICAL VILLAGE DRIVE, EDGEWOOD, KY 41017
(859) 341-7246
(859) 341-7867
Mailing address
20 MEDICAL VILLAGE DRIVE, #258, EDGEWOOD, KY 41017
(859) 341-7246
(859) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1102067
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000355022
ANTHEM BLUE SHIELD
—
01
—
2547971
MEDICAID
OH
05
—
74009622
—
KY
Enumeration date
03/17/2006
Last updated
02/28/2008
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