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NPI Code Detail

MEDICARE: BRAYDON DAVIS

MEDICARE: BRAYDON DAVIS
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
1390200000XStudent in an Organized Health Care Education/Training ProgramSD

General Provider Information

NPI Number : 1417873332
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAYDON DAVIS
Provider Business Mailing Address
First Line : 113 COMANCHE RD
Second Line :
City : FORT MEADE
State : SD
Zip : 57741-1002
Country : US
Telephone Number : 605-520-1584
Fax Number :
Provider Business Practice Location Address
First Line : 113 COMANCHE RD
Second Line :
City : FORT MEADE
State : SD
Zip : 57741-1002
Country : US
Telephone Number : 605-347-2511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2026
Last Update Date : 06/25/2026

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Directions to “ BRAYDON DAVIS ” Practice Location

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