Provider Demographics
NPI:1639110935
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:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:456 N NEW BALLAS RD
Practice Address - Street 2:SUITE 129
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6831
Practice Address - Country:US
Practice Address - Phone:314-569-1881
Practice Address - Fax:314-569-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000010765Medicare ID - Type Unspecified
IL209426Medicare ID - Type Unspecified
MO000013454Medicare ID - Type Unspecified