Individual
DR. JUSTIN MARK DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5501 N PORTLAND AVE, OKLAHOMA CITY, OK 73112-2074
(405) 604-6000
Mailing address
PO BOX 248875, SUITE 300, OKLAHOMA CITY, OK 73124-8875
(918) 392-2944
(918) 664-2521
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
27437
OK
207L00000X
Anesthesiology Physician
Primary
BP1-0026250
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200286500A
—
OK
01
—
3849060601
MYUTMB 3849060601-COMMERCIAL NUMBER
—
Enumeration date
06/14/2007
Last updated
01/30/2014
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