MEDICARE: JOHN L DAVIS JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301103346	MI

General Provider Information

NPI Number	:	1184062465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN L DAVIS JR. M.D.

Provider Business Mailing Address
First Line	:	4328 BUTEO DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4328 BUTEO DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7239
Country	:	US
Telephone Number	:	269-998-9297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	09/23/2022

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