Healthcare Provider Details

I. General information

NPI: 1295995694
Provider Name (Legal Business Name): FRANCE A DAVIS II PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 CHIPETA WAY
SALT LAKE CITY UT
84108-1287
US

IV. Provider business mailing address

PO BOX 581289
SALT LAKE CITY UT
84158-1289
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-7575
  • Fax: 801-587-7471
Mailing address:
  • Phone: 801-587-7575
  • Fax: 801-587-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number757567-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number757567-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: