Healthcare Provider Details

I. General information

NPI: 1104918879
Provider Name (Legal Business Name): JOHN ALLEN DAVIS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 ROBERT BLVD
SLIDELL LA
70458-2009
US

IV. Provider business mailing address

PO BOX 1224
SLIDELL LA
70459-1224
US

V. Phone/Fax

Practice location:
  • Phone: 985-520-0909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number019868
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: