Provider Demographics
NPI:1255483293
Name:DAVIS, RONALD EUGENE (LMP)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:EUGENE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8407 18TH AVE W APT 3-103
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7914
Mailing Address - Country:US
Mailing Address - Phone:425-346-1529
Mailing Address - Fax:
Practice Address - Street 1:800 164TH ST SE
Practice Address - Street 2:STE N
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6301
Practice Address - Country:US
Practice Address - Phone:425-742-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist