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General NPI Number Information
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NPI Number | 1043480056
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Entity Type | Individual
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Provider Name | JOHN HOWARD DAVIDSON PA
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Gender | Male
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 405 W JACKSON ST
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City | CARBONDALE
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State | IL
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Zip | 62901-1462
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Country | US
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Telephone | 618-549-0721
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Fax | 618-457-0469
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Provider Business Mailing Address
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Address Line | 16091 SWINGLEY RIDGE RD SUITE #100
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City | CHESTERFIELD
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State | MO
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Zip | 63017-2056
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Country | US
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Telephone | 636-728-2200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085001572
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License Number State | IL
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