Provider Demographics
NPI:1902805849
Name:DAVIS, JOHN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
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 1:2345 E PRATER WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9634
Mailing Address - Country:US
Mailing Address - Phone:702-853-3300
Mailing Address - Fax:702-640-0604
Practice Address - Street 1:5320 S RAINBOW BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1896
Practice Address - Country:US
Practice Address - Phone:702-853-3300
Practice Address - Fax:702-640-0604
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8606208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002970Medicaid
NV002002970Medicaid
020045445Medicare PIN
G67715Medicare UPIN