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Individual

JAKE COBURN DAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CPO, MSPO

Contact information

Practice address
635 N MAIN ST STE 691, RICHFIELD, UT 84701-1895
(801) 820-0087
(801) 820-2852
Mailing address
635 N MAIN ST STE 691, RICHFIELD, UT 84701-1895
(801) 820-0087
(801) 820-2852

Taxonomy

Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CO005925
224P00000X
Prosthetist
Primary
CPO04745

Other

Enumeration date
03/03/2020
Last updated
11/14/2022
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