Individual
CHARLES O DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2981 W 4TH ST, ONTARIO, OH 44906-1267
(419) 709-8640
(419) 709-8641
Mailing address
700 N COLUMBUS ST, CRESTLINE, OH 44827-1455
(419) 468-0505
(419) 468-2381
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.004153
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112909
—
OH
Enumeration date
10/20/2014
Last updated
12/29/2020
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