Provider Demographics
NPI:1487820320
Name:DAVIS, KIMBERLY JO (DO)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1174E GRAYSTONE WAY 15
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2678
Mailing Address - Country:US
Mailing Address - Phone:801-557-7785
Mailing Address - Fax:801-486-0174
Practice Address - Street 1:1174E GRAYSTONE WAY 15
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84106-2678
Practice Address - Country:US
Practice Address - Phone:801-486-0875
Practice Address - Fax:801-486-0174
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT6348762-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine