Individual
DENNON W DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4105 N WATER TOWER PL, MOUNT VERNON, IL 62864-6296
(618) 244-9495
(618) 244-9497
Mailing address
4105 N WATER TOWER PL, MOUNT VERNON, IL 62864-6296
(618) 244-9495
(618) 244-9497
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036099669
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
047016
HEALTH ALLIANCE
—
01
—
080137051
RAILROAD MEDICARE
—
01
—
10019630
BCBS
—
01
—
334689
HEALTH LINK
—
Enumeration date
08/18/2006
Last updated
09/05/2024
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