Individual
DERRICK DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1063 DUCKWOOD DR APT 205, EAGAN, MN 55123-1206
(612) 518-6455
Mailing address
1063 DUCKWOOD DR APT 205, EAGAN, MN 55123-1206
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2527
MN
Other
Enumeration date
07/14/2014
Last updated
07/14/2014
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