Individual
BRIAN MARK DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2510 AIRPARK DR STE 301, REDDING, CA 96001-2462
(530) 242-3500
(530) 242-3546
Mailing address
3400 DATA DR, ATTN CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 18631
CA
Other
Enumeration date
10/16/2006
Last updated
10/30/2019
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