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General NPI Number Information
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NPI Number | 1326379975
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Entity Type | Organization
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Legal Business Name | KEITH L DAVIS MD
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Dates
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Enumeration Date | 01/21/2010
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 2420 LAKE AVE
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City | ASHTABULA
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State | OH
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Zip | 44004-2420
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Country | US
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Telephone | 440-994-7582
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Fax | 440-994-7539
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Provider Business Mailing Address
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Address Line | PO BOX 3111
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City | WARREN
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State | OH
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Zip | 44485-3111
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Country | US
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Telephone | 800-673-5312
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Fax | 888-817-7141
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Authorized Official
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Title or Position | OWNER OF JEFFERSON BILLING, INC
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Name | MS. LINDA MCGIRR
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Credential |
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Telephone | 800-673-5312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 052285
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License Number State | OH
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