Individual
MARK C DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
123 C AVE, LAKE OSWEGO, OR 97034-2353
(503) 905-9006
(503) 238-0841
Mailing address
123 C AVE, LAKE OSWEGO, OR 97034-2353
(503) 905-9006
(503) 238-0841
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01047
OR
363AS0400X
Surgical Physician Assistant
PA01047
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044615
—
OR
Enumeration date
12/14/2006
Last updated
12/24/2024
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