Provider Demographics
NPI:1942224852
Name:DAVIS, DAN F (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:F
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 JASMINE ST
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-7105
Mailing Address - Country:US
Mailing Address - Phone:979-836-0972
Mailing Address - Fax:979-836-0972
Practice Address - Street 1:3107 JASMINE ST
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-7105
Practice Address - Country:US
Practice Address - Phone:979-836-0972
Practice Address - Fax:979-836-0972
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00674363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741648333OtherTAX ID
TX80N499Medicare PIN