Provider Demographics
NPI:1093095598
Name:DAVIS DERMATOLOGY PC
Entity Type:Organization
Organization Name:DAVIS DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EARLYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:NOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-756-5758
Mailing Address - Street 1:132 E STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4651
Mailing Address - Country:US
Mailing Address - Phone:530-756-5758
Mailing Address - Fax:530-756-5753
Practice Address - Street 1:132 E STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4651
Practice Address - Country:US
Practice Address - Phone:530-756-5758
Practice Address - Fax:530-756-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty