MEDICARE: MR. JULIAN ARMAND DAVIS

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	1744P3200X	Prosthetics Case Management	1704450989	NV
2	1744P3200X	Prosthetics Case Management	C-34997	NV

General Provider Information

NPI Number	:	1275069361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JULIAN ARMAND DAVIS

Provider Business Mailing Address
First Line	:	5575 SIMMONS ST
Second Line	:	SUITE 1-174
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-9009
Country	:	US
Telephone Number	:	702-721-8863
Fax Number	:

Provider Business Practice Location Address
First Line	:	5710 SIMMONS ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-9900
Country	:	US
Telephone Number	:	702-721-8863
Fax Number	:

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

Provider Enumeration Date	:	05/10/2017
Last Update Date	:	05/10/2017

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