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Individual

BENNY C DAVIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
709 MIDDLE CREEK RD, SEVIERVILLE, TN 37862-5047
(952) 442-9770
Mailing address
233 W 1ST ST, WACONIA, MN 55387-1302
(952) 442-9770
(952) 442-3620

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN52524
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3028585
BLUE CROSS BLUE SHIELD
TN
05
3601996
TN
Enumeration date
10/24/2005
Last updated
12/06/2013
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