MEDICARE: CORY DAWN DAVIS PA-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
1	363A00000X	Physician Assistant	10710	AZ
2	363AM0700X	Medical Physician Assistant	10710	AZ
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1821788563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY DAWN DAVIS PA-C

Provider Business Mailing Address
First Line	:	10200 GRAND CENTRAL AVE STE 220
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5670 N PROFESSIONAL PARK DR STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-7821
Country	:	US
Telephone Number	:	520-618-1010
Fax Number	:	520-784-7040

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	03/21/2025

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Directions to “ CORY DAWN DAVIS PA-C” Practice Location

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