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NPI Code Detail

MEDICARE: DALTON ALAN DAVIS

MEDICARE: DALTON ALAN DAVIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1023504230
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALTON ALAN DAVIS
Provider Business Mailing Address
First Line : 2215 VICTORY PKWY APT D5
Second Line :
City : CINCINNATI
State : OH
Zip : 45206-2831
Country : US
Telephone Number : 614-905-9057
Fax Number :
Provider Business Practice Location Address
First Line : 3800 VICTORY PKWY UNIT 1
Second Line :
City : CINCINNATI
State : OH
Zip : 45207-1092
Country : US
Telephone Number : 513-745-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2018
Last Update Date : 07/11/2018

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