Individual
BRADLEY V DAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1225 S GRAND BLVD, SAINT LOUIS, MO 63104-1016
(314) 977-5200
(314) 977-3495
Mailing address
3691 RUTGER AVE, PROVIDER ENROLLMENT, ST LOUIS, MO 63110
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
102555
MO
Other
Enumeration date
07/24/2006
Last updated
11/04/2020
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