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1750607966

NPI Code Detail

MEDICARE: JESSICA LEE DAVIS MD

MEDICARE: JESSICA LEE 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A121159	CA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD60542731	WA
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD185584	OR
4	207ZP0213X	Pediatric Pathology Physician	MD185584	OR
5	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	01088834A	IN

General Provider Information

NPI Number	:	1750607966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEE DAVIS MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5165 MCCARTY LN
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-8764
Country	:	US
Telephone Number	:	765-448-8000
Fax Number	:

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

Provider Enumeration Date	:	04/13/2010
Last Update Date	:	10/17/2022

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Directions to “ JESSICA LEE DAVIS MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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