Individual
MARK D DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6500 HARRIS PKWY, FORT WORTH, TX 76132-4136
(817) 263-2600
(817) 263-2805
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-2987
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601004142
MI
363A00000X
Physician Assistant
PA06442
TX
363AM0700X
Medical Physician Assistant
Primary
PA06442
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110F335760
BCBSM
MA
05
—
208650601
—
TX
Enumeration date
08/02/2006
Last updated
06/01/2023
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