Provider Demographics
NPI:1366867459
Name:MARC J DAVIS, MD
Entity Type:Organization
Organization Name:MARC J DAVIS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-900-3331
Mailing Address - Street 1:1174 E 2760 S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2673
Mailing Address - Country:US
Mailing Address - Phone:801-900-3331
Mailing Address - Fax:801-649-5651
Practice Address - Street 1:1174 E 2760 S
Practice Address - Street 2:SUITE 4
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2673
Practice Address - Country:US
Practice Address - Phone:801-900-3331
Practice Address - Fax:801-649-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty