Basic Information
| Provider Information | |||||||||
| NPI: | 1811924780 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLES I DAVIS MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9250 GLENWOOD ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662121365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136488880 | ||||||||
| FaxNumber: | 9136488881 | ||||||||
| Practice Location | |||||||||
| Address1: | 9250 GLENWOOD ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662121365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136488880 | ||||||||
| FaxNumber: | 9136488881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 06/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | ISAAC | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9136488880 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 0429493 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.