Individual
KEVIN LEE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1306 13TH ST, BRIDGEPORT, TX 76426-2454
(940) 648-1402
(940) 648-1400
Mailing address
PO BOX 1500, BRIDGEPORT, TX 76426-1500
(940) 255-6552
(940) 202-7058
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
PA10658
TX
363AM0700X
Medical Physician Assistant
Primary
PA10658
TX
Other
Enumeration date
06/02/2016
Last updated
07/22/2024
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