Healthcare Provider Details

I. General information

NPI: 1861502783
Provider Name (Legal Business Name): JASON L DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MEDICAL PKWY STE C
CEDAR PARK TX
78613-7886
US

IV. Provider business mailing address

1401 MEDICAL PKWY STE 100
CEDAR PARK TX
78613-7642
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-4812
  • Fax: 512-324-2771
Mailing address:
  • Phone: 512-324-4812
  • Fax: 512-324-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberL0784
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD207771
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD00046375
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: