Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 376411-1205 | UT |
NPI | 1013092709 |
---|---|
Provider Name | Jennifer Jean Davis |
First Address | Salt Lake City, UT 84141-3034 |
Second Address | Salt Lake City, UT 84132-0100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 19/10/2021 |