Provider Demographics
NPI:1093737371
Name:DAVIS, TERRY (PA)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 W POST RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2417
Mailing Address - Country:US
Mailing Address - Phone:702-430-5333
Mailing Address - Fax:702-430-5335
Practice Address - Street 1:6170 N DURANGO DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3923
Practice Address - Country:US
Practice Address - Phone:702-430-5333
Practice Address - Fax:702-430-5335
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00377724OtherRAILROAD MEDICARE
NV38414Medicare UPIN
NVP00377724OtherRAILROAD MEDICARE