Davis, Jason

Davis, Jason is an individual health care provider with primary practice located at 3900 Park Nicollet Blvd , St Louis Park MN 55416-2503. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Davis, Jason can be contacted via phone (952) 883-3150.

Contact Information

Primary practice address
3900 Park Nicollet Blvd St Louis Park MN 55416-2503
Phone: (952) 883-3150
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 10786 Minnesota
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 10786 Minnesota

Profile Details

NPI number 1306170808
LBN Legal business name Davis, Jason
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 30th, 2009
Last updated Mar 17th, 2018 - about 6 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 1306170808 NPPES
Minnesota MEDICAID 1306170808

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