Provider Demographics
NPI:1972888378
Name:DAVIS, MARK GABRIEL (ND)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GABRIEL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5432 N MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4548
Mailing Address - Country:US
Mailing Address - Phone:971-231-4325
Mailing Address - Fax:971-239-1913
Practice Address - Street 1:5432 N MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4548
Practice Address - Country:US
Practice Address - Phone:971-231-4325
Practice Address - Fax:971-239-1913
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1842175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath