MEDICARE: NATHAN W DAVIS D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	49208910501	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00057743	OTHER	UT	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	123401800	OTHER	UT	US DEPT OF LABOR
2	49208910503001	OTHER	UT	BLUE CROSS BLUE SHIELD
3	QM000061991	OTHER	UT	ALTUIS
4	2700110	OTHER	UT	UNITED HEALTH CARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	731650218	OTHER	UT	COMMERCIAL
8	731650218DAV	OTHER	UT	EDUCATORS MUTUAL

General Provider Information

NPI Number	:	1730165572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN W DAVIS D.P.M.

Provider Business Mailing Address
First Line	:	154 MYRTLE AVE
Second Line	:	SUITE 201
City	:	MURRAY
State	:	UT
Zip	:	84107-4833
Country	:	US
Telephone Number	:	801-743-2909
Fax Number	:	801-288-9505

Provider Business Practice Location Address
First Line	:	154 MYRTLE AVE
Second Line	:	SUITE 201
City	:	MURRAY
State	:	UT
Zip	:	84107-4833
Country	:	US
Telephone Number	:	801-743-2909
Fax Number	:	801-288-9505

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	05/30/2011

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