MEDICARE: JOHN DANIEL DAVIS MD

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	207P00000X	Emergency Medicine Physician	35 - 038969	OH

General Provider Information

NPI Number	:	1558456780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DANIEL DAVIS MD

Provider Business Mailing Address
First Line	:	4249 NEW MARKET BANTA RD
Second Line	:
City	:	LEWISBURG
State	:	OH
Zip	:	45338-7745
Country	:	US
Telephone Number	:	937-962-9347
Fax Number	:	937-962-9027

Provider Business Practice Location Address
First Line	:	4249 NEW MARKET BANTA RD
Second Line	:
City	:	LEWISBURG
State	:	OH
Zip	:	45338-7745
Country	:	US
Telephone Number	:	937-962-9347
Fax Number	:	937-962-9027

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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