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General NPI Number Information
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NPI Number | 1821284159
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Entity Type | Organization
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Legal Business Name | DMHD FAMILY PRACTICE, INC.
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 1320 BELMONT AVE STE 2
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City | YOUNGSTOWN
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State | OH
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Zip | 44504-1130
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Country | US
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Telephone | 330-746-0607
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Fax | 330-744-2101
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Provider Business Mailing Address
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Address Line | 1320 BELMONT AVE STE 2
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City | YOUNGSTOWN
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State | OH
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Zip | 44504-1130
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Country | US
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Telephone | 330-746-0607
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Fax | 330-744-2101
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Authorized Official
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Title or Position | CEO
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Name | DAVID MICHAEL DAVIS
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Credential | M.D.
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Telephone | 330-746-0607
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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 | 35075817
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License Number State | OH
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