Individual
DR. JOHN RUSSELL DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4320 WORNALL RD, SUITE 50, KANSAS CITY, MO 64111-5941
(816) 931-3312
(816) 531-9862
Mailing address
4320 WORNALL RD, SUITE 50, KANSAS CITY, MO 64111-5941
(816) 931-3312
(816) 531-9862
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
04-34175
KS
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
2010001724
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149549001
—
AR
05
—
200009120A
—
OK
05
—
209231208
—
MO
01
—
MA1815
MEDICARE
MO
Enumeration date
01/17/2006
Last updated
03/20/2013
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