Individual
JOHN DAVIS SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
339 KINGS RIDGE BLVD, O FALLON, IL 62269-6327
(618) 624-2969
Mailing address
339 KINGS RIDGE BLVD, O FALLON, IL 62269-6327
(618) 624-2969
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041341411
IL
163W00000X
Registered Nurse
2004009573
MO
Other
Enumeration date
11/06/2013
Last updated
11/06/2013
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