MEDICARE: AMY DAVIS M.D.

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	207Q00000X	Family Medicine Physician	35609	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679559546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY DAVIS M.D.

Provider Business Mailing Address
First Line	:	2635 N 7TH ST
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-8209
Country	:	US
Telephone Number	:	970-298-7578
Fax Number	:	970-298-1809

Provider Business Practice Location Address
First Line	:	2698 PATTERSON RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8818
Country	:	US
Telephone Number	:	970-298-2800
Fax Number	:	970-298-6902

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	02/03/2015

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