Individual
DR. WILLIE BOB DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ME
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
KS 04-17213
KS
207Q00000X
Family Medicine Physician
MO R5059
MO
2085R0202X
Diagnostic Radiology Physician
Primary
04-17213
KS
2085R0202X
Diagnostic Radiology Physician
R5059
MO
208D00000X
General Practice Physician
04-17213
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10001780C
—
KS
05
—
201018322
—
MO
Enumeration date
06/15/2005
Last updated
04/19/2022
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