Basic Information
| Provider Information | |||||||||
| NPI: | 1609825926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | CRAIG | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183601027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704210170 | ||||||||
| FaxNumber: | 5704245167 | ||||||||
| Practice Location | |||||||||
| Address1: | 1803 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183601027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704210170 | ||||||||
| FaxNumber: | 5704245167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2006 | ||||||||
| LastUpdateDate: | 11/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD030272E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.