MEDICARE: JESSICA 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	207P00000X	Emergency Medicine Physician	373482-1205	UT

General Provider Information

NPI Number	:	1780980532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DAVIS M.D.

Provider Business Mailing Address
First Line	:	1273 E BRYAN AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1273 E BRYAN AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2509
Country	:	US
Telephone Number	:	801-366-1884
Fax Number	:

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

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	08/14/2014

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