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Individual

DR. JOHN MATTISON DAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
6211 WATERFORD BLVD, EVANSVILLE, IN 47715-2869
(812) 465-6202
Mailing address
6211 WATERFORD BLVD, EVANSVILLE, IN 47715-2869
(812) 465-6202

Taxonomy

Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
0101264206
VA
2084P0800X
Psychiatry Physician
Primary
0101264206
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100127820
KY
01
P00872494
RR MEDICARE
KY
Enumeration date
01/30/2006
Last updated
12/26/2023
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