Provider Demographics
NPI:1306541735
Name:DAVIS, JOSHUA JOHN (TWH, PSS)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JOHN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:TWH, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 SE LAKE RD STE 302
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2148
Mailing Address - Country:US
Mailing Address - Phone:503-351-7268
Mailing Address - Fax:
Practice Address - Street 1:6902 SE LAKE RD STE 302
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97267-2148
Practice Address - Country:US
Practice Address - Phone:503-351-7268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist