Individual
TODD JEFFREY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
170 N 1100 E, AMERICAN FORK, UT 84003-2096
(480) 213-7512
Mailing address
PO BOX 430, SPANISH FORK, UT 84660-0430
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
28454
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245268390
—
UT
01
—
67477411200001
BCBS
UT
01
—
P00460269
RAIL ROAD MEDICARE
—
Enumeration date
06/29/2006
Last updated
05/14/2008
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