Doctor Name: | DR. JOHN THOMAS DAVIS |
NPI Number: | 1063436756 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 036-115943 |
Business Practice Address: | 510 Lincoln Drive Herrin, IL - 62948 |
Business Phone Number: | 6189976800 |
Business Fax Number: | 6189971187 |
Mailing Address: | 510 Lincoln Drive, HERRIN |
State: | IL |
Postal Code: | 62948 |
Phone Number: | 6189976800 |
Fax Number: | 6189971187 |
NPI Enumeration Date: | 07/26/2006 |
NPI Last Update Date: | 05/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 036-115943 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |