=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265825376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHASE ALEXANDER DAVIS PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2015
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1661 SAINT ANTHONY AVE FL 2
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-3742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-968-5300
-----------------------------------------------------
Fax | 651-968-5903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 COMMERCE DR STE 200
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55125-4925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-968-5201
-----------------------------------------------------
Fax | 651-968-5903
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 13627
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------