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General NPI Number Information
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NPI Number | 1750607966
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Entity Type | Individual
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Provider Name | JESSICA LEE DAVIS MD
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Gender | Female
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 5165 MCCARTY LN
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City | LAFAYETTE
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State | IN
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Zip | 47905-8764
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Country | US
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Telephone | 765-448-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | A121159
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD60542731
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD185584
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 207ZP0213X
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Taxonomy Name | Pediatric Pathology Physician
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License Number | MD185584
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 01088834A
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License Number State | IN
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