Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A107197 | CA |
N | 111NI0900X | Internist | A107197 | CA |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD172197 | OR |
N | 207RC0000X | Internist - Cardiovascular Disease | MD172197 | OR |
NPI | 1538303276 |
---|---|
Provider Name | Dr. Jonathan David Davis |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2009 |
Last Update Date | 07/11/2017 |