Provider Demographics
NPI:1467036459
Name:DAVIS, EDWARD PAUL
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:PAUL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 11TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2461
Mailing Address - Country:US
Mailing Address - Phone:701-340-0665
Mailing Address - Fax:
Practice Address - Street 1:30 11TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2461
Practice Address - Country:US
Practice Address - Phone:701-340-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty