Healthcare Provider Details

I. General information

NPI: 1710148564
Provider Name (Legal Business Name): JOHN DYLAN DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HOSPITAL DR
HURRICANE WV
25526-9202
US

IV. Provider business mailing address

PO BOX 3466
CHARLESTON WV
25334-3466
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-8816
  • Fax: 904-494-6467
Mailing address:
  • Phone: 304-720-8816
  • Fax: 904-494-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24859
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: