Provider Demographics
NPI:1023217742
Name:DAVIS, JOSALEEN MUZQUIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSALEEN
Middle Name:MUZQUIZ
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:1055 WESTGATE DR
Practice Address - Street 2:STE 100
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1451
Practice Address - Country:US
Practice Address - Phone:122-627-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53790207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110014721Medicare UPIN