Davis, Charles J

Davis, Charles J is an individual health care provider with primary practice located at 14410 Se Petrovitsky Rd Ste 104 , Renton WA 98058-8900. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Davis, Charles J can be contacted via phone (425) 690-3405.

Contact Information

Primary practice address
14410 Se Petrovitsky Rd Ste 104 Renton WA 98058-8900
Phone: (425) 690-3405
Fax: (425) 690-9405
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA10004461 Washington

Profile Details

NPI number 1962422956
LBN Legal business name Davis, Charles J
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2006
Last updated Mar 31st, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962422956 NPPES
Washington Other G8971468 MEDICARE W VALLEY MEDICAL GROUP - RENTON
Washington MEDICAID 1023188 MEDICARE W VALLEY MEDICAL GROUP - RENTON

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