Healthcare Provider Details

I. General information

NPI: 1568102705
Provider Name (Legal Business Name): JAMES BRIAN DAVIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 CENTERVILLE BUSINESS PKWY STE 117
CENTERVILLE OH
45459-2690
US

IV. Provider business mailing address

24 CARNABY DR
BROWNSBURG IN
46112-1062
US

V. Phone/Fax

Practice location:
  • Phone: 973-296-9806
  • Fax: 937-296-9805
Mailing address:
  • Phone: 317-447-7533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36004205
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: