Individual
DAVIS JORDON EVERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1115 12TH AVE RD, NAMPA, ID 83686-5738
(208) 498-1080
(208) 498-1081
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2509
ID
Other
Enumeration date
05/31/2023
Last updated
12/08/2023
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