MEDICARE: TROY A DAVIS PA-C

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	PA10004684	OR
2	207N00000X	Dermatology Physician	PA10004684	WA
3	363A00000X	Physician Assistant	MEDPAC126298	MT

General Provider Information

NPI Number	:	1790793685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY A DAVIS PA-C

Provider Business Mailing Address
First Line	:	2835 FORT MISSOULA RD STE 302
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-7424
Country	:	US
Telephone Number	:	406-721-3497
Fax Number	:	406-721-3487

Provider Business Practice Location Address
First Line	:	2835 FORT MISSOULA RD STE 302
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-7424
Country	:	US
Telephone Number	:	406-721-3497
Fax Number	:	406-721-3487

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	03/03/2026

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