Provider Demographics
NPI:1043493125
Name:DAVIS, ROBERT T (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:13065 W MCDOWELL RD SUITE 107
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392
Mailing Address - Country:US
Mailing Address - Phone:623-907-8686
Mailing Address - Fax:623-907-8440
Practice Address - Street 1:13065 W MCDOWELL RD STE A107
Practice Address - Street 2:PHOENIX GI CONSULTANTS
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6440
Practice Address - Country:US
Practice Address - Phone:623-907-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2015-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1080501363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant