Individual
DR. JOHN LAWRENCE DAVISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 N 16TH ST, NEW CASTLE, IN 47362-4319
(765) 521-0890
(765) 521-1555
Mailing address
PO BOX 485, NEW CASTLE, IN 47362-0485
(765) 521-0890
(765) 521-1555
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01077390A
IN
207R00000X
Internal Medicine Physician
48216
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201377670
—
IN
01
—
P01723965
RR MEDICARE
IN
Enumeration date
05/26/2012
Last updated
09/09/2020
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