Provider Demographics
NPI:1346425410
Name:DAVIS, JOHN BERTRAND (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BERTRAND
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 ISABEL DR
Mailing Address - Street 2:
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-3511
Mailing Address - Country:US
Mailing Address - Phone:239-470-1020
Mailing Address - Fax:
Practice Address - Street 1:1307 ISABEL DR
Practice Address - Street 2:
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957-3511
Practice Address - Country:US
Practice Address - Phone:239-470-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0039739207YS0123X
LAMD.207761207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11986OtherBC/BS
FL11986OtherBC/BS