Active NPI
Jerry Gale Davidson, P.A.
- Physician Assistant
- Hobart, OK
National Provider Identifier
1790928935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA 194
- Practice address
- 429 W Elm St
Hobart, OK 73651-1615 - Phone
- (580) 726-3324
- NPI assigned
- Apr 17, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 194 | OK | Primary |
Addresses
Primary practice location
429 W Elm St
Hobart, OK 73651-1615
Mailing address
208 N Lowe St
Hobart, OK 73651-2422
Phone (580) 726-2209
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)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 194 | OK | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239926400000",
"number": "1790928935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 N LOWE ST",
"city": "HOBART",
"state": "OK",
"postal_code": "736512422",
"telephone_number": "580-726-2209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "429 W ELM ST",
"city": "HOBART",
"state": "OK",
"postal_code": "736511615",
"telephone_number": "580-726-3324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "JERRY",
"middle_name": "GALE",
"name_prefix": "Mr.",
"credential": "P.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-04-17",
"last_updated": "2009-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "PA 194",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hobart, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.