Healthcare Provider Details

I. General information

NPI: 1447562764
Provider Name (Legal Business Name): CHRISTOPHER DAVIS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 WOODROW ST SUITE 200
MURRAY UT
84107-5841
US

IV. Provider business mailing address

5323 WOODROW ST SUITE 200
MURRAY UT
84107-5841
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-1020
  • Fax: 801-747-1023
Mailing address:
  • Phone: 801-747-1020
  • Fax: 801-747-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7709033-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: