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Individual

MR. KENT CHARLES DAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
411 3RD ST N, WAITE PARK, MN 56387-1177
(320) 253-4120
(320) 253-4179
Mailing address
411 3RD ST N STE 4, WAITE PARK, MN 56387-0003
(320) 253-4120
(320) 253-4179

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
31759
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
110587C851
UCARE
01
1520376
MEDICA
05
561597600
MN
01
8L641DA
BCBS
01
92224583001
PREFERRED ONE
01
HP25413
HEALTH PARTNERS
Enumeration date
06/15/2006
Last updated
01/09/2024
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