Healthcare Provider Details

I. General information

NPI: 1265178552
Provider Name (Legal Business Name): ANTHONY JAMES DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 GRAND AVE APT 326
WEST DES MOINES IA
50265-5050
US

IV. Provider business mailing address

1800 GRAND AVE APT 326
WEST DES MOINES IA
50265-5050
US

V. Phone/Fax

Practice location:
  • Phone: 563-271-9844
  • Fax:
Mailing address:
  • Phone: 563-271-9844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14618
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number139793
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: