Individual
RYAN MICHAEL DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
(618) 256-7804
Mailing address
310 WEST LOSEY, SCOTT AFB, IL 62225-5250
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
05/06/2009
Last updated
05/06/2009
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