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Individual

LASAN DAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
203 WEST LEE STREET, TUSKEGEE, AL 36083
(334) 727-7050
(334) 727-6284
Mailing address
203 WEST LEE ST, TUSKEGEE, AL 36083
(334) 727-7050
(334) 727-6284

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13059
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
51524383
BLUE CROSS BLUE SHIELD
AL
Enumeration date
06/09/2006
Last updated
04/07/2008
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