Individual
PATRICK W DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C.
Contact information
Practice address
724 KENDALL LN, BOULDER CITY, NV 89005-1112
(702) 604-7422
(702) 549-3178
Mailing address
PO BOX 752287, LAS VEGAS, NV 89136-2287
(702) 604-7422
(702) 549-3178
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA823
NV
363AS0400X
Surgical Physician Assistant
PA823
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100502933
—
NV
05
—
850273
—
AZ
01
—
CC535Y
MEDICARE PTAN
NV
01
—
P00206370
RAILROAD MEDICARE
NV
01
—
PA823
NSBME
NV
Enumeration date
04/28/2006
Last updated
10/22/2019
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