Active NPI
Andrew David Davalt, PAC
- Surgical Physician Assistant
- Denver, CO
National Provider Identifier
1164445185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA 2257
- Practice address
- 2045 N Franklin St
Denver, CO 80205-5437 - Phone
- (303) 338-4545
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA 2257 | CO | Primary |
Addresses
Primary practice location
2045 N Franklin St
Denver, CO 80205-5437
Mailing address
10350 E Dakota Ave
Denver, CO 80247-1314
Other practice location 1
3277 S Lincoln St
Englewood, CO 80113-2512
Phone (303) 762-0808
Other practice location 2
3277 S Lincoln St
Englewood, CO 80113
Phone (303) 762-0808
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA 2257 | Other | CO | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 2257 | CO | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619568000000",
"number": "1164445185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10350 E DAKOTA AVE",
"city": "DENVER",
"state": "CO",
"postal_code": "802471314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2045 N FRANKLIN ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802055437",
"telephone_number": "303-338-4545"
}
],
"practiceLocations": [
{
"address_1": "3277 S Lincoln St",
"address_purpose": "LOCATION",
"city": "Englewood",
"state": "CO",
"postal_code": "801132512",
"country_code": "US",
"telephone_number": "303-762-0808",
"fax_number": "303-762-9292",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3277 S Lincoln St",
"address_purpose": "LOCATION",
"city": "Englewood",
"state": "CO",
"postal_code": "80113",
"country_code": "US",
"telephone_number": "303-762-0808",
"fax_number": "303-762-9292",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAVALT",
"first_name": "ANDREW",
"middle_name": "DAVID",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2021-04-28",
"certification_date": "2021-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "CO",
"license": "PA 2257",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "PA 2257",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.