Provider Demographics
NPI:1003857749
Name:DAVIS, LABRONZ C (MD)
Entity Type:Individual
Prefix:
First Name:LABRONZ
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2872 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2645
Mailing Address - Country:US
Mailing Address - Phone:614-279-9905
Mailing Address - Fax:614-279-0213
Practice Address - Street 1:2872 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2645
Practice Address - Country:US
Practice Address - Phone:614-279-9905
Practice Address - Fax:614-279-0213
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2138154Medicaid
OHDA0895843Medicare PIN