Provider Demographics
NPI:1962484725
Name:DAVIS, JOHN ANTHONY (PHD MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:DAVIS
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Gender:M
Credentials:PHD MD
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Mailing Address - Street 1:700 ACKERMAN ROAD, SUITE 385
Mailing Address - Street 2:OSU INTERNAM MEDICINE, LLC
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-947-3700
Mailing Address - Fax:614-947-3771
Practice Address - Street 1:456 W 10TH AVE
Practice Address - Street 2:DIVISION OF INFECTIOUS DISEASE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1228
Practice Address - Country:US
Practice Address - Phone:614-293-5667
Practice Address - Fax:614-293-4556
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2008-12-16
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Provider Licenses
StateLicense IDTaxonomies
OH092205207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2861836Medicaid
OH2861836Medicaid