Healthcare Provider Details

I. General information

NPI: 1669657540
Provider Name (Legal Business Name): DAVIS, WRIGHT, BERDY & SUFFIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BOWLES AVE SUITE G10
FENTON MO
63026-2395
US

IV. Provider business mailing address

456 N NEW BALLAS RD SUITE 129
SAINT LOUIS MO
63141-6831
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-1881
  • Fax: 314-569-3277
Mailing address:
  • Phone: 314-569-1881
  • Fax: 314-569-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAY S DAVIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-569-1881