Individual
DR. LAWRENCE GUSTAVO DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6767 WEST 29TH STREET, GREELEY, CO 80634
(970) 652-2426
(970) 652-2478
Mailing address
6767 W 29TH ST, GREELEY, CO 80634-5474
(706) 522-4269
(970) 652-2478
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
47358
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025926100
—
NE
05
—
133142600
—
WY
05
—
39126544
—
CO
01
—
P01022528
RR MEDICARE
CO
Enumeration date
11/02/2005
Last updated
10/14/2020
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