Provider Demographics
NPI:1437123064
Name:DAVIES, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:DAVIES
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 1:600 JOHN DEERE RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6869
Mailing Address - Country:US
Mailing Address - Phone:309-779-3627
Mailing Address - Fax:309-779-4500
Practice Address - Street 1:600 JOHN DEERE RD
Practice Address - Street 2:SUITE 401
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6869
Practice Address - Country:US
Practice Address - Phone:309-779-3627
Practice Address - Fax:309-779-4500
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1437123064Medicaid
ILP01122700OtherRR MEDICARE
IL0182OtherJOHN DEERE
IA0579458Medicaid
IA036053919002Medicaid
94027OtherBCWELLMARK
IL036053919Medicaid
IA1579458Medicaid
110112638OtherRR MEDICARE
143158OtherIHS
IA036053919002Medicaid
94027OtherBCWELLMARK