Individual
TISH D DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2235 E GALA ST, MERIDIAN, ID 83642-8026
(208) 887-3724
(208) 887-1682
Mailing address
425 W BANNOCK ST, BOISE, ID 83702-6035
(208) 343-1702
(208) 342-7042
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1576
ID
Other
Enumeration date
06/08/2006
Last updated
07/22/2019
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