Individual
DR. JASON TYLER DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7910 FROST ST STE 250, SAN DIEGO, CA 92123-2752
(858) 637-4800
(858) 637-4801
Mailing address
4225 EXECUTIVE SQ STE 450, LA JOLLA, CA 92037-8411
(858) 810-0000
(858) 268-1911
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A100799
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A100799
CA LICENSE
CA
01
—
BR072X
SO CA MEDICARE PTAN
CA
Enumeration date
01/17/2008
Last updated
01/29/2021
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