Provider Demographics
NPI:1811904212
Name:DAVIES, JOHN BRANDON (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRANDON
Last Name:DAVIES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3601 W 76TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-3004
Mailing Address - Country:US
Mailing Address - Phone:404-798-4001
Mailing Address - Fax:952-897-1178
Practice Address - Street 1:7760 FRANCE AVE S
Practice Address - Street 2:SUITE 310
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55435-5800
Practice Address - Country:US
Practice Address - Phone:952-929-1131
Practice Address - Fax:952-897-1178
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-09-01
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Provider Licenses
StateLicense IDTaxonomies
MN51687207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200493906Medicaid
IL$$$$$$$$$Medicaid
968020103Medicare PIN
MO200493906Medicaid