Individual
DR. STEPHEN E DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4 DEERWOOD AVE NW, WADENA, MN 56482-1253
(218) 631-1360
Mailing address
415 JEFFERSON ST N, WADENA, MN 56482-1264
(218) 631-3510
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33510
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
867203200
—
MN
Enumeration date
08/23/2006
Last updated
06/01/2015
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