Provider Demographics
NPI:1558384511
Name:DAVIS, JESSICA A (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:DAVIS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:781 HUDSON AVE, SUITE 2
Mailing Address - City:STILLWATER
Mailing Address - State:NY
Mailing Address - Zip Code:12170-0173
Mailing Address - Country:US
Mailing Address - Phone:518-664-6116
Mailing Address - Fax:866-874-7242
Practice Address - Street 1:781 HUDSON AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:STILLWATER
Practice Address - State:NY
Practice Address - Zip Code:12170
Practice Address - Country:US
Practice Address - Phone:518-664-6116
Practice Address - Fax:866-874-7242
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-07-01
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Provider Licenses
StateLicense IDTaxonomies
NY247491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine