Individual
CHARLES BRADFORD DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
243 CURTISS RD STE 100, BARKSDALE AFB, LA 71110-2425
(318) 456-6555
Mailing address
243 CURTISS RD STE 100, BARKSDALE AFB, LA 71110-2425
(318) 456-6555
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1161436
NCCPA NUMBER
—
Enumeration date
02/07/2019
Last updated
07/12/2024
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