Provider Demographics
NPI:1801878095
Name:DAVIS, JAMES WALTER (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WALTER
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:465 EDGEHILL DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9445
Mailing Address - Country:US
Mailing Address - Phone:435-797-1660
Mailing Address - Fax:435-797-3585
Practice Address - Street 1:9100 OLD MAIN HILL
Practice Address - Street 2:850 EAST 1200 NORTH
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-0001
Practice Address - Country:US
Practice Address - Phone:435-797-1660
Practice Address - Fax:435-797-3585
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT164124-1205207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD26488Medicare UPIN