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General NPI Number Information
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NPI Number | 1154506020
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Entity Type | Organization
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Legal Business Name | DAVIS, WRIGHT, BERDY, & SUFFIAN, PC
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 4325 ALBY ST SUITE 101
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City | ALTON
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State | IL
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Zip | 62002-5914
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Country | US
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Telephone | 618-465-9753
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Fax | 314-569-3277
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Provider Business Mailing Address
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Address Line | 456 N NEW BALLAS RD SUITE 129
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6831
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Country | US
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Telephone | 314-569-1881
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Fax | 314-569-3277
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAY S DAVIS
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Credential | M.D.
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Telephone | 314-569-1881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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