Davis, Charles R

Davis, Charles R is an individual health care provider with primary practice located at 4004 Beyer Blvd , San Ysidro CA 92173-2007. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Davis, Charles R can be contacted via phone (303) 579-9268.

Contact Information

Primary practice address
4004 Beyer Blvd San Ysidro CA 92173-2007
Phone: (303) 579-9268
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 21195 Colorado
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X G41219 California

Profile Details

NPI number 1194840231
LBN Legal business name Davis, Charles R
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 20th, 2007
Last updated Apr 4th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194840231 NPPES
Colorado MEDICAID 01211952
Colorado Other 110519276
Colorado MEDICAID PENDING

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