Healthcare Provider Details

I. General information

NPI: 1811904212
Provider Name (Legal Business Name): JOHN BRANDON DAVIES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7760 FRANCE AVE S SUITE 310
MINNEAPOLIS MN
55435-5800
US

IV. Provider business mailing address

3601 W 76TH ST STE 300
EDINA MN
55435-3004
US

V. Phone/Fax

Practice location:
  • Phone: 952-929-1131
  • Fax: 952-897-1178
Mailing address:
  • Phone: 404-798-4001
  • Fax: 952-897-1178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number51687
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number51687
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: