Healthcare Provider Details

I. General information

NPI: 1912643826
Provider Name (Legal Business Name): DAVIS JOON LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 UNIVERSITY DR STE 110
FAIRBORN OH
45324-6255
US

IV. Provider business mailing address

2555 UNIVERSITY DR STE 110
FAIRBORN OH
45324-6255
US

V. Phone/Fax

Practice location:
  • Phone: 937-775-8188
  • Fax:
Mailing address:
  • Phone: 937-775-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34.017513
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: