Healthcare Provider Details

I. General information

NPI: 1124168943
Provider Name (Legal Business Name): JAMES BRADEN DAVIS ED.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 W MERRILL DR
SAINT DAVID AZ
85630-6147
US

IV. Provider business mailing address

338 W MERRILL DR
SAINT DAVID AZ
85630-6147
US

V. Phone/Fax

Practice location:
  • Phone: 520-720-5363
  • Fax: 520-720-5363
Mailing address:
  • Phone: 520-720-5363
  • Fax: 520-720-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: