Individual
DR. LARRY R DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2051 190TH STREET, FORT DODGE, IA 50501
(515) 573-8487
Mailing address
2051 190TH STREET, FORT DODGE, IA 50501
(515) 573-8487
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
20999
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2146944
—
IA
01
—
43844
WELLMARK BCBS OF IA
IA
01
—
A014
TRIWEST
—
01
—
IA0109
JOHN DEERE HEALTH
IA
Enumeration date
11/18/2005
Last updated
07/08/2007
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