Provider Demographics
NPI:1558456780
Name:DAVIS, JOHN DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DANIEL
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 1:4249 NEW MARKET BANTA RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45338-7745
Mailing Address - Country:US
Mailing Address - Phone:937-962-9347
Mailing Address - Fax:937-962-9027
Practice Address - Street 1:4249 NEW MARKET BANTA RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:45338-7745
Practice Address - Country:US
Practice Address - Phone:937-962-9347
Practice Address - Fax:937-962-9027
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 - 038969207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine