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General NPI Number Information
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NPI Number | 1154367324
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Entity Type | Individual
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Provider Name | DAVIS L BRONSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 355 CHARDONNAY AVE
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City | PROSSER
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State | WA
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Zip | 99350-9521
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Country | US
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Telephone | 509-781-6366
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 719
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City | SUNNYSIDE
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State | WA
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Zip | 98944-0719
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Country | US
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Telephone | 509-837-1617
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 2002029450
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License Number State | MO
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