Individual
RYAN DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2875 JAMES BLVD, POPLAR BLUFF, MO 63901-3395
(573) 686-6657
Mailing address
1615 N 14TH ST, POPLAR BLUFF, MO 63901-2922
(573) 718-8238
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/11/2014
Last updated
06/11/2014
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