Provider Demographics
NPI:1932767357
Name:DAVIS, JACOB PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:PATRICK
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 E BROAD ST # 980470
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-5025
Mailing Address - Country:US
Mailing Address - Phone:804-828-6600
Mailing Address - Fax:804-828-6129
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5023
Practice Address - Country:US
Practice Address - Phone:804-828-6600
Practice Address - Fax:804-828-6129
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2024-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01012712072085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology