Provider Demographics
NPI:1144335597
Name:DAVIES, KURT JOHN (PA-C)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:JOHN
Last Name:DAVIES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4182 TEXAS ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1653
Mailing Address - Country:US
Mailing Address - Phone:619-543-9858
Mailing Address - Fax:
Practice Address - Street 1:9745 PROSPECT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-6209
Practice Address - Country:US
Practice Address - Phone:619-448-4841
Practice Address - Fax:619-448-8700
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant