Provider Demographics
NPI:1154506020
Name:DAVIS, WRIGHT, BERDY, & SUFFIAN, PC
Entity Type:Organization
Organization Name:DAVIS, WRIGHT, BERDY, & SUFFIAN, PC
Other - Org Name:ALLERGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-569-1881
Mailing Address - Street 1:456 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6831
Mailing Address - Country:US
Mailing Address - Phone:314-569-1881
Mailing Address - Fax:314-569-3277
Practice Address - Street 1:4325 ALBY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5914
Practice Address - Country:US
Practice Address - Phone:618-465-9753
Practice Address - Fax:314-569-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209426Medicare PIN