MEDICARE: TERRY DAVIS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	584	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00377724	OTHER	NV	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1093737371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY DAVIS PA

Provider Business Mailing Address
First Line	:	9097 W POST RD
Second Line	:	STE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2417
Country	:	US
Telephone Number	:	702-430-5333
Fax Number	:	702-430-5335

Provider Business Practice Location Address
First Line	:	6170 N DURANGO DR STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3923
Country	:	US
Telephone Number	:	702-430-5333
Fax Number	:	702-430-5335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	09/14/2020

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Directions to “ TERRY DAVIS PA” Practice Location

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