Individual
JOHN HOWARD DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
540 W WALLACE ST, SHAWNEE, OK 74801-5722
(405) 777-8275
Mailing address
101 N UNION AVE, SHAWNEE, OK 74801-7067
(405) 777-8275
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
1750905808
OK
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/04/2020
Last updated
06/07/2021
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