Provider Demographics
NPI:1578692901
Name:DAVIS, DENIS D (PA)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 MURPHY RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4346
Mailing Address - Country:US
Mailing Address - Phone:541-772-5548
Mailing Address - Fax:541-245-0919
Practice Address - Street 1:691 MURPHY RD
Practice Address - Street 2:SUITE 209
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4346
Practice Address - Country:US
Practice Address - Phone:541-772-5548
Practice Address - Fax:541-245-0919
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00930363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR116663Medicare ID - Type Unspecified
R04621Medicare UPIN