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General NPI Number Information
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NPI Number | 1063040590
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Entity Type | Individual
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Provider Name | JONATHON SAMUEL DAVIS DO
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Gender | Male
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 550 N HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67214-4976
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Country | US
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Telephone | 503-413-7074
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Fax | 503-413-6892
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Provider Business Mailing Address
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Address Line | 4443 N GREY MEADOWS ST
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City | MAIZE
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State | KS
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Zip | 67101-5200
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Country | US
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Telephone | 515-297-1491
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 05-50922
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License Number State | KS
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