Provider Demographics
NPI:1407919335
Name:DAVIS, ROBERT F (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:F
Last Name:DAVIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 ROAD 81
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-9160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 W HIGH ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4308
Practice Address - Country:US
Practice Address - Phone:419-998-4573
Practice Address - Fax:419-998-4586
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-116353367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0245765Medicaid
OH0245765Medicaid
R54279Medicare UPIN