Individual
MR. BRIAN A DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2115
(417) 820-5344
Mailing address
PO BOX 504274, SAINT LOUIS, MO 63150-4274
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2004002413
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790891851
—
MO
Enumeration date
08/22/2006
Last updated
01/22/2016
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