Healthcare Provider Details

I. General information

NPI: 1417914730
Provider Name (Legal Business Name): PATRICK W DAVIS P.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 KENDALL LN
BOULDER CITY NV
89005-1112
US

IV. Provider business mailing address

PO BOX 752287
LAS VEGAS NV
89136-2287
US

V. Phone/Fax

Practice location:
  • Phone: 702-604-7422
  • Fax: 702-549-3178
Mailing address:
  • Phone: 702-604-7422
  • Fax: 702-549-3178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA823
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA823
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: