Davis, Mark L.

Davis, Mark L. is an individual health care provider with primary practice located at 3315 Kethley Rd , Shawnee OK 74804-9638. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Davis, Mark L. can be contacted via phone (405) 273-5801.

Contact Information

Primary practice address
3315 Kethley Rd Shawnee OK 74804-9638
Phone: (405) 273-5801
Fax: (405) 878-3814
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA801 Oklahoma

Profile Details

NPI number 1487747713
LBN Legal business name Davis, Mark L.
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 30th, 2006
Last updated Aug 29th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487747713 NPPES
Oklahoma MEDICAID 100715900B

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