Provider Demographics
NPI:1194776864
Name:DAVIS, JASON M (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE 265
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4724
Mailing Address - Country:US
Mailing Address - Phone:804-594-2622
Mailing Address - Fax:804-594-0915
Practice Address - Street 1:10800 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 265
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4724
Practice Address - Country:US
Practice Address - Phone:804-594-2622
Practice Address - Fax:804-594-0915
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238342207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA56793OtherCARENET
VAI35156Medicare UPIN
VA008000C37Medicare ID - Type Unspecified
VAP00258408Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER