Individual
JOHN HOWARD DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 457-0469
Mailing address
16091 SWINGLEY RIDGE RD, SUITE #100, CHESTERFIELD, MO 63017-2056
(636) 728-2200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085001572
IL
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085001572
ILLINOIS LICENSE
IL
Enumeration date
03/05/2008
Last updated
01/11/2021
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