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Individual

BRYAN T. DAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.

Contact information

Practice address
5319 HOAG DR, SUITE 210 A, SHEFFIELD VILLAGE, OH 44035-1494
(440) 723-5685
(440) 723-5686
Mailing address
PO BOX 378, SANDUSKY, OH 44871-0378
(419) 609-1112
(419) 609-1123

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50-00-1266
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000383079
BLUECROSS BLUESHIELD
OH
Enumeration date
01/24/2006
Last updated
11/03/2015
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