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General NPI Number Information
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NPI Number | 1235793324
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Entity Type | Individual
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Provider Name | RICHARD DAVIES CAA
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Gender | Male
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 05/24/2019
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Provider Practice Location Address
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Address Line | 110 IRVING ST NW
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City | WASHINGTON
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State | DC
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Zip | 20010-3017
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Country | US
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Telephone | 202-877-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 339 CONSORT DR
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City | BALLWIN
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State | MO
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Zip | 63011-4439
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Country | US
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Telephone | 636-386-9224
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Fax | 636-386-7679
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 2019016628
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License Number State | MO
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