MEDICARE: JAIME LEE DAVIS M.D.

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	207N00000X	Dermatology Physician	37613	MN

General Provider Information

NPI Number	:	1326063439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME LEE DAVIS M.D.

Provider Business Mailing Address
First Line	:	408 RIVER ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-2530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 W LAKE ST
Second Line	:	SUITE 208
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-3397
Country	:	US
Telephone Number	:	612-455-3200
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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