Provider Demographics
NPI:1629613310
Name:DAVIS, DONALD LEE
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:LEE
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 1:1459 WILD BLOSSOM WAY
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7635
Mailing Address - Country:US
Mailing Address - Phone:225-270-5055
Mailing Address - Fax:303-663-7476
Practice Address - Street 1:1459 WILD BLOSSOM WAY
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7635
Practice Address - Country:US
Practice Address - Phone:225-270-5055
Practice Address - Fax:303-663-7476
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLL-03041347C00000X, 347E00000X, 344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker