Basic Information
| Provider Information | |||||||||
| NPI: | 1922068212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | BRADLEY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.A.-C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5770 SOUTH 250 EAST | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841078241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013142225 | ||||||||
| FaxNumber: | 8013142345 | ||||||||
| Practice Location | |||||||||
| Address1: | 5770 SOUTH 250 EAST | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841078241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013142225 | ||||||||
| FaxNumber: | 8013142345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 09/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 103792-1206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.