Provider Demographics
NPI:1366702797
Name:PATRICK DAVIS PA-C LTD
Entity type:Organization
Organization Name:PATRICK DAVIS PA-C LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:702-604-7422
Mailing Address - Street 1:PO BOX 752287
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89136-2287
Mailing Address - Country:US
Mailing Address - Phone:702-604-7422
Mailing Address - Fax:908-345-8788
Practice Address - Street 1:724 KENDALL LN
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-1112
Practice Address - Country:US
Practice Address - Phone:702-604-7422
Practice Address - Fax:908-345-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA823363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20091190921OtherNV SOS BUSINESS LICENSE