Healthcare Provider Details

I. General information

NPI: 1124080593
Provider Name (Legal Business Name): JON ROBERT DAVIDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 STOCKTON BLVD.
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2425 STOCKTON BLVD.
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-2049
  • Fax: 916-453-2202
Mailing address:
  • Phone: 916-453-2049
  • Fax: 916-453-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberG68422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: