Individual
BRIAN DAVAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8 JOHN KISSINGER DR, WABASH, IN 46992-1648
(260) 563-7451
(260) 569-2284
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01082532A
IN
Other
Enumeration date
06/15/2018
Last updated
10/11/2022
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