Healthcare Provider Details

I. General information

NPI: 1841501087
Provider Name (Legal Business Name): BARBARA HANNA DAVIS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 AUDUBON PLAZA DR STE 220
LOUISVILLE KY
40217-1319
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6251
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-7242
  • Fax: 502-636-7130
Mailing address:
  • Phone: 25-889-4905
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number04098
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: