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General NPI Number Information
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NPI Number | 1316439201
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Entity Type | Organization
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Legal Business Name | ENNIS PHYSICAL MEDICINE, PLLC
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 109 NW MAIN ST STE B
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City | ENNIS
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State | TX
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Zip | 75119-4079
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Country | US
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Telephone | 972-293-9355
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Fax | 915-206-5076
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Provider Business Mailing Address
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Address Line | 109 NW MAIN ST STE B
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City | ENNIS
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State | TX
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Zip | 75119-4079
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Country | US
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Telephone | 972-293-9355
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. WILLIAM CAMERON DAVIS
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Credential | DC
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Telephone | 972-293-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | K5597
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License Number State | TX
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