Individual
DR. MARK E DAVANZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35051847
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2986050
—
OH
01
—
P00880716
RR MEDICARE
OH
Enumeration date
06/15/2006
Last updated
03/28/2019
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