Provider Demographics
NPI:1215066246
Name:DAVIS, TIMOTHY P (PAC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9327 W 3RD STREET
Mailing Address - Street 2:100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:602-371-3100
Mailing Address - Fax:602-371-0050
Practice Address - Street 1:9327N 3RD STREET
Practice Address - Street 2:100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-371-3100
Practice Address - Fax:602-371-0050
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1200207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant