MEDICARE: MR. BRUCE BERNARD DAVIS II

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952534539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE BERNARD DAVIS II

Provider Business Mailing Address
First Line	:	4101 NW EXPRESSWAY
Second Line	:	APT. 16131
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1700
Country	:	US
Telephone Number	:	405-532-2741
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 NW EXPRESSWAY
Second Line	:	APT. 16131
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1700
Country	:	US
Telephone Number	:	405-532-2741
Fax Number	:

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

Provider Enumeration Date	:	08/28/2009
Last Update Date	:	08/28/2009

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