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General NPI Number Information
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NPI Number | 1447481908
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Entity Type | Organization
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Legal Business Name | GREGG E DAVIS MD LTD
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 204 PARK AVE E
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City | PRINCETON
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State | IL
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Zip | 61356-2114
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Country | US
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Telephone | 815-879-3212
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Fax | 815-879-8602
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Provider Business Mailing Address
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Address Line | 204 PARK AVE E
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City | PRINCETON
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State | IL
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Zip | 61356-2114
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Country | US
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Telephone | 815-879-3212
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Fax | 815-879-8602
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Authorized Official
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Title or Position | CEO
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Name | DR. GREGG E DAVIS
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Credential | MD
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Telephone | 815-879-3212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036-058885
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License Number State | IL
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