Individual
JASON DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3900 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416-2503
(952) 883-3150
Mailing address
3900 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416-2503
(952) 883-3150
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10786
MN
363AM0700X
Medical Physician Assistant
10786
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306170808
—
MN
Enumeration date
09/30/2009
Last updated
03/17/2018
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