Individual
DR. BRENT RYAN DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1011 BOWLES AVE, SUITE 415, FENTON, MO 63026-2395
(636) 717-1700
(636) 203-4727
Mailing address
1011 BOWLES AVE, SUITE 200, FENTON, MO 63026-2395
(636) 717-1700
(636) 203-4727
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
2005009915
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10032015
BLUECROSS BLUESHIELD
IL
01
—
109208
HEALTH ALLIANCE
MO
01
—
113109
HEALTH ALLIANCE
IL
01
—
199422
BLUE CROSS BLUE SHIELD
MO
05
—
207319807
—
MO
01
—
226523
GROUP HEALTH PLAN
MO
01
—
5617586
FIRST HEALTH
MO
01
—
714579
HEALTHLINK
IL
01
—
714579
HEALTHLINK
—
01
—
753168118
UNITED HEALTHCARE
—
01
—
P00238356
RAILROAD MEDICARE
MO
01
—
P00339415
RAILROAD MEDICARE
IL
Enumeration date
03/09/2006
Last updated
01/23/2015
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