Individual
JASON DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
267 N CANYON DR, GOODING, ID 83330-5500
(208) 934-4446
(208) 934-4442
Mailing address
267 N CANYON DR, GOODING, ID 83330-5500
(208) 934-4446
(208) 934-4442
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06785
TX
Other
Enumeration date
07/01/2010
Last updated
08/26/2022
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