Individual
JASON SCOTT DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2200 FORT JESSE RD, NORMAL, IL 61761-6286
(309) 664-3491
Mailing address
35 SUNSET RD, BLOOMINGTON, IL 61701-2016
(309) 452-1788
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
281929
MA
2085R0202X
Diagnostic Radiology Physician
MD2018-0966
NM
2085U0001X
Diagnostic Ultrasound Physician
Primary
036101068
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL2613
MEDICARE GROUP #
—
Enumeration date
07/11/2006
Last updated
10/22/2024
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