Provider Demographics
NPI:1639286560
Name:DAVIS, JOHN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:220 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5809
Mailing Address - Country:US
Mailing Address - Phone:830-896-4711
Mailing Address - Fax:830-257-0878
Practice Address - Street 1:220 WESLEY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5809
Practice Address - Country:US
Practice Address - Phone:830-896-4711
Practice Address - Fax:830-257-0878
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE2531OtherPHY LIC
TX103795402Medicaid
TX892129Medicare ID - Type UnspecifiedTEXAS
TXD48194Medicare UPIN