| Doctor Name: | RYAN CORY DAVIS |
| NPI Number: | 1003191115 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | PA2015-003 |
| Business Practice Address: | 4901 Lang Ave Ne Suite 100 Albuquerque, NM - 871094495 |
| Business Phone Number: | 5058832574 |
| Business Fax Number: | |
| Mailing Address: | 9180 Coors Blvd Nw, Apt 3902 ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871203112 |
| Phone Number: | 5053578333 |
| Fax Number: | |
| NPI Enumeration Date: | 10/20/2011 |
| NPI Last Update Date: | 05/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA2015-003 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |