Individual
BRAD JACOB DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-8364
Mailing address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-8364
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
44532
MN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
44532
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
321314500
—
MN
Enumeration date
07/05/2006
Last updated
05/19/2011
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