Individual
JULIO G DAVALOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
806 LANDMARK DR, SUITE 118, GLEN BURNIE, MD 21061-4980
(410) 780-9400
(410) 787-1911
Mailing address
25 CROSSROADS DR, SUITE 306, OWINGS MILLS, MD 21117-5421
(410) 760-9400
(410) 787-1911
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
21678
WV
208800000X
Urology Physician
Primary
D72502
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043860000
—
MD
01
—
E279/0107
BLUE CHOICE
MD
Enumeration date
10/21/2006
Last updated
04/25/2014
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