Provider Demographics
NPI:1346227113
Name:DAVIS, MITCHELL RYAN (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:RYAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1921 STONECIPHER BLVD
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-3439
Mailing Address - Country:US
Mailing Address - Phone:580-421-4570
Mailing Address - Fax:580-272-5731
Practice Address - Street 1:1921 STONECIPHER BOULEVARD
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3439
Practice Address - Country:US
Practice Address - Phone:580-421-6260
Practice Address - Fax:580-272-5731
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-09-08
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Provider Licenses
StateLicense IDTaxonomies
OK20654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG72679Medicare UPIN