Individual
MARK OWEN DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3501 KNICKERBOCKER RD, SAN ANGELO, TX 76904-7610
(800) 893-9698
Mailing address
2502 NASWORTHY DR, SAN ANGELO, TX 76904-5423
(325) 949-0413
(866) 204-1259
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
F9353
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139438919
—
TX
01
—
DA8V0608
BLUE SHIELD
TX
Enumeration date
07/04/2006
Last updated
12/08/2017
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