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NPI Code Detail

MEDICARE: PATRICIA S DAVIS P A-C

MEDICARE: PATRICIA S DAVIS P A-C
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
1363AM0700XMedical Physician Assistant1985AZ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1118264OTHERAZMEDICARE PTAN

General Provider Information

NPI Number : 1366492274
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA S DAVIS P A-C
Provider Business Mailing Address
First Line : 1250 S CLEARVIEW AVE STE 100
Second Line : URGENT CARE EXTRA
City : MESA
State : AZ
Zip : 85209-3378
Country : US
Telephone Number : 480-988-9108
Fax Number : 480-813-4460
Provider Business Practice Location Address
First Line : 641 W WARNER RD
Second Line :
City : GILBERT
State : AZ
Zip : 85233-7266
Country : US
Telephone Number : 480-722-9828
Fax Number : 480-722-9831
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 08/25/2015

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Directions to “ PATRICIA S DAVIS P A-C” Practice Location

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