Individual
MARK DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
902 LAKEVIEW AVE, PUEBLO, CO 81004-3597
(719) 557-5855
Mailing address
902 LAKEVIEW AVE, PUEBLO, CO 81004-3597
(719) 557-5855
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3209
CO
Other
Enumeration date
06/21/2011
Last updated
06/21/2011
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