Provider Demographics
NPI:1205875465
Name:DAVIS, JOHN C (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:DAVIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:12255 DE PAUL DR
Mailing Address - Street 2:SUITE 490
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2510
Mailing Address - Country:US
Mailing Address - Phone:314-291-7766
Mailing Address - Fax:314-291-7767
Practice Address - Street 1:12255 DE PAUL DR
Practice Address - Street 2:SUITE 490
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2510
Practice Address - Country:US
Practice Address - Phone:314-291-7766
Practice Address - Fax:314-291-7767
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MOR7C02208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics