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General NPI Number Information
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NPI Number | 1487095659
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Entity Type | Individual
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Provider Name | JARED DAVIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE # MC2030
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City | CHICAGO
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State | IL
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Zip | 60637-1447
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Country | US
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Telephone | 773-702-6390
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Fax |
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Provider Business Mailing Address
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Address Line | 3377 RIVERBEND DR
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City | SPRINGFIELD
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State | OR
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Zip | 97477-8803
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Country | US
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Telephone | 541-222-8400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number | 036-142866
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD70054286
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number | 04-51975
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD227513
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number | NCC5557
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License Number State | IL
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