MEDICARE: DR. JASON TYLER DAVIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	A100799	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	BR072X	OTHER	CA	SO CA MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A100799	OTHER	CA	CA LICENSE

General Provider Information

NPI Number	:	1295911469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON TYLER DAVIS MD

Provider Business Mailing Address
First Line	:	4225 EXECUTIVE SQ STE 450
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-8411
Country	:	US
Telephone Number	:	858-810-0000
Fax Number	:	858-268-1911

Provider Business Practice Location Address
First Line	:	7910 FROST ST STE 250
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2752
Country	:	US
Telephone Number	:	858-637-4800
Fax Number	:	858-637-4801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	01/29/2021

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