Provider Demographics
NPI:1588662050
Name:DAVIS, JASON (DO)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
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 1:3940 N MARQUETTE ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-4430
Mailing Address - Country:US
Mailing Address - Phone:563-386-3111
Mailing Address - Fax:
Practice Address - Street 1:3940 N MARQUETTE ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-4430
Practice Address - Country:US
Practice Address - Phone:563-386-3111
Practice Address - Fax:563-386-3113
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA3392208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34933OtherBCBS OF IOWA
IA4261008Medicaid
IAH73064Medicare UPIN
IA4261008Medicaid