Healthcare Provider Details

I. General information

NPI: 1326093998
Provider Name (Legal Business Name): JOHN A DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

283 E 930 S
OREM UT
84058-5001
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-1700
  • Fax:
Mailing address:
  • Phone: 801-225-6246
  • Fax: 801-225-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number018094
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number9258
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number180687-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier107005493101
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerIHC
# 2
Identifier681072
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerDMBA #
# 3
Identifier870487570004
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer
# 4
Identifier870487570DA1
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerEMIA #
# 5
Identifier300080588
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerR/R MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: