Provider Demographics
NPI:1730165572
Name:DAVIS, NATHAN W (DPM)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:154 MYRTLE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4833
Mailing Address - Country:US
Mailing Address - Phone:801-743-2909
Mailing Address - Fax:801-288-9505
Practice Address - Street 1:154 MYRTLE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4833
Practice Address - Country:US
Practice Address - Phone:801-743-2909
Practice Address - Fax:801-288-9505
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT49208910501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT123401800OtherUS DEPT OF LABOR
UT49208910503001OtherBLUE CROSS BLUE SHIELD
UTQM000061991OtherALTUIS
UT2700110OtherUNITED HEALTH CARE
NV002189004Medicaid
UTP00057743OtherMEDICARE RAILROAD
UT731650218OtherCOMMERCIAL
UT731650218DAVOtherEDUCATORS MUTUAL
UT2700110OtherUNITED HEALTH CARE
UT005721401Medicare PIN
UTQM000061991OtherALTUIS
UTP00057743OtherMEDICARE RAILROAD