Provider Demographics
NPI:1588649891
Name:DAVIS, JOHN B (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17 EXCHANGE ST W
Mailing Address - Street 2:#750
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1045
Mailing Address - Country:US
Mailing Address - Phone:651-232-4340
Mailing Address - Fax:651-232-4198
Practice Address - Street 1:17 EXCHANGE ST W
Practice Address - Street 2:#750
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1045
Practice Address - Country:US
Practice Address - Phone:651-232-4340
Practice Address - Fax:651-232-4198
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MN46186207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34425700Medicaid
WI34425700Medicaid
E73916Medicare UPIN