MARK DAVIS (NPI# 1023304821) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023304821 |
| Entity Type | Individual |
| Full Name | MARK DAVIS |
| Credential | PA-C |
| Practice Address |
902 Lakeview Ave Pueblo CO 81004-3597 |
| Practice Telephone | 7195575855 |
| Mailing Telephone | 7195575855 |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2011-06-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 3209 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780225250 | Mark N Davis | Psychologist | 1479 Oak Ridge Dr, Chico, CA 95928-8856 | 2019-10-04 |
| 1841731924 | Mark Davis | Anesthesiology | 8237 Blackburn Ave Apt 103, Los Angeles, CA 90048-4277 | 2017-03-09 |
| 1336599588 | Mark Randall Davis | Specialist/Technologist | 1437 6th Street Cir Nw, Hickory, NC 28601-5255 | 2016-06-20 |
| 1891104865 | Mark Davis | Home Health Aide | 1916 Millgate Rd, Anderson, SC 29621-2936 | 2014-08-04 |
| 1457786998 | Mark Henderson Davis | Social Worker | 5384 Street Ne, Community Options Fridley, Fridley, MN 55421 | 2013-09-03 |
| 1699114082 | Mark David Davis | Behavioral Analyst | 12420 S Ridgeland Ave, Palos Heights, IL 60463-1858 | 2013-06-18 |
| 1376813808 | Mark Stephen Davis | Specialist | 4453 Mount Paran Pkwy Nw, Atlanta, GA 30327-3721 | 2011-12-30 |
| 1295053254 | Mark Davis | Pharmacist | 4185 Washington Rd, Mc Murray, PA 15317-2522 | 2010-05-13 |
| 1194968826 | Mark Anthony Davis | Driver | 448 E 272nd St, Euclid, OH 44132-1730 | 2009-04-10 |
| 1750542460 | Mark Alan Davis Sr. | Counselor | 147 Bryn Mawr Ave, Lansdowne, PA 19050-1806 | 2008-06-24 |
| Street Address |
902 LAKEVIEW AVE |
| City | PUEBLO |
| State | CO |
| Zip Code | 81004-3597 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376549840 | Laura A Stein | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004 | 2005-06-21 |
| 1972114676 | Catholic Health Initiatives Colorado | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-08-14 |
| 1275154668 | Alexander Thomas Grover | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-04-27 |
| 1336769843 | Sydney Marie Brock | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-04-24 |
| 1225658172 | Ashima Singh | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-04-21 |
| 1467072249 | Joel Scott Bonzo | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-04-21 |
| 1023638053 | Patrick Henke | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-04-20 |
| 1659991917 | Kelsi Rae Brown | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2020-04-16 |
| 1205474210 | John De Villa | Nurse Practitioner | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2019-12-20 |
| 1033773627 | Queenter Kisang | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2019-04-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780155929 | Renee C Lane | Nurse Practitioner | 1925 E. Orman Ave. Ste. A109, Pueblo, CO 81004 | 2018-12-16 |
| 1215406913 | Kaiser Foundation Healthplan of Colorado | Pharmacy | 2625 W. Pueblo Blvd, Pueblo, CO 81004 | 2018-11-26 |
| 1053895532 | Rebecka Ann Reatherford | Nurse Practitioner | St Mary-corwin Medical Center, 1008 Minnequa Ave, Pueblo, CO 81004 | 2018-09-20 |
| 1124510821 | Angela M Sillas-green | Counselor | 327 Colorado Ave., Pueblo, CO 81004 | 2018-05-30 |
| 1558898569 | Alexandra R B King | Family Medicine | Southern Colorado Family Medicine, 902 Lakeview Avenue, Pueblo, CO 81004 | 2017-05-22 |
| 1578098752 | James Williams | Counselor | 414 Broadway Ave, Pueblo, CO 81004 | 2017-04-26 |
| 1740732601 | Valerie A Senger | Counselor | 635 W Corona Ave Ste 214, Pueblo, CO 81004 | 2016-10-26 |
| 1194111500 | A New Leaf Therapy, Pllc | Community/Behavioral Health | 327 Colorado Ave, Pueblo, CO 81004 | 2015-04-13 |
| 1619371671 | Mariah Mcginnis | Registered Nurse | 1232 Van Buren St., Pueblo, CO 81004 | 2014-10-20 |
| 1730593112 | Maritza Martinez | Registered Nurse | 1026 Wabriendo Ave, Pueblo, CO 81004 | 2014-06-13 |
| Find all providers in zip 81004 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114527652 | Li Ashley Lim | Physician Assistant | 132 W B St Apt 3k, Pueblo, CO 81003-3446 | 2020-10-26 |
| 1104366178 | Alfe Garperio | Physician Assistant | 2625 W Pueblo Blvd, Pueblo, CO 81004-3816 | 2017-02-24 |
| 1871895995 | A Theodore Smith | Physician Assistant | 1600 West 24th Street, Colorado Mental Health Institute At Pueblo, Pueblo, CO 81003 | 2010-11-22 |
| 1689793812 | Paul Whitney Safford | Physician Assistant | 600 West 16th St, Pueblo, CO 81003 | 2007-03-28 |
| 1740347996 | Jose Luis Ramirez | Physician Assistant | 45825 Highway 96 East, Pueblo, CO 81006 | 2007-01-03 |
| 1932217635 | Juliana Schrettner | Physician Assistant | 1600 N Greenwood, 520, Pueblo, CO 81003 | 2006-08-25 |
| 1427046077 | James L Kramer | Physician Assistant | 1008 Minnegua Ave, Emergency Room, Pueblo, CO 81004 | 2005-10-07 |
| 1306846381 | Lucas R Derting | Physician Assistant | 1600 North Grand Avenue, Suite 500, Pueblo, CO 81003-2757 | 2005-07-29 |
| 1922001700 | Stephen D Bast | Physician Assistant | 3676 Parker Blvd, Pueblo, CO 81008-2212 | 2005-05-24 |
| 1245863257 | Anna Elizabeth Inserra | Physician Assistant | 1315 Fortino Blvd, Pueblo, CO 81008-1981 | 2020-02-18 |
| Find all providers in PUEBLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.