Provider Demographics
NPI:1316975501
Name:DAVIS, JAN G (MD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:G
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1600 N GRAND AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2730
Mailing Address - Country:US
Mailing Address - Phone:719-595-7260
Mailing Address - Fax:719-595-7265
Practice Address - Street 1:1600 N GRAND AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2730
Practice Address - Country:US
Practice Address - Phone:719-595-7260
Practice Address - Fax:719-595-7265
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO30574207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01305747Medicaid
COCE8738Medicare PIN
COE70792Medicare UPIN