Provider Demographics
NPI:1437530110
Name:DAVIS, JOHNATHAN LEE WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:LEE WILLIAM
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 RIDGEGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5522
Mailing Address - Country:US
Mailing Address - Phone:720-225-1322
Mailing Address - Fax:720-225-1329
Practice Address - Street 1:10101 RIDGEGATE PKWY
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5522
Practice Address - Country:US
Practice Address - Phone:720-225-1322
Practice Address - Fax:720-225-1329
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR0061976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program