Provider Demographics
NPI:1891938684
Name:DAVIS, JARED (MD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 E 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3013
Mailing Address - Country:US
Mailing Address - Phone:785-979-7790
Mailing Address - Fax:
Practice Address - Street 1:9901 E 26TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3013
Practice Address - Country:US
Practice Address - Phone:785-979-7790
Practice Address - Fax:415-354-3430
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH0051084207R00000X
CO51084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23775556Medicaid
CO022821OtherKAISER COMMERCIAL NUMBER
CO23775556Medicaid