Provider Demographics
NPI:1558660498
Name:DAVIS ENT SPECIALISTS, PC
Entity Type:Organization
Organization Name:DAVIS ENT SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-686-7346
Mailing Address - Street 1:407 S MEDICAL ARTS CT
Mailing Address - Street 2:STE. C
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3372
Mailing Address - Country:US
Mailing Address - Phone:307-686-7346
Mailing Address - Fax:307-682-1485
Practice Address - Street 1:407 S MEDICAL ARTS CT
Practice Address - Street 2:STE. C
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3372
Practice Address - Country:US
Practice Address - Phone:307-686-7346
Practice Address - Fax:307-682-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7762A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies