MEDICARE: MR. HOWARD EUGENE DAVIS CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1659454510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HOWARD EUGENE DAVIS CPO

Provider Business Mailing Address
First Line	:	924 3RD AVE
Second Line	:
City	:	CROCKETT
State	:	CA
Zip	:	94525-1403
Country	:	US
Telephone Number	:	510-222-1282
Fax Number	:	510-222-1284

Provider Business Practice Location Address
First Line	:	2970 HILLTOP MALL RD
Second Line	:	SUITE 104
City	:	RICHMOND
State	:	CA
Zip	:	94806-1947
Country	:	US
Telephone Number	:	510-222-1282
Fax Number	:	510-222-1284

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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