Individual
BENJAMIN RAY DAVIS
Active
Individual
BENJAMIN RAY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
52963
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912919804
TYPE 2 NPI
CA
01
—
52963
MEDICAL LICENSE
CA
01
—
GRP. NPI: 1912919804
MEDI-CAL
CA
Enumeration date
10/19/2015
Last updated
07/21/2022
Update your record
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