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General NPI Number Information
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NPI Number | 1346425410
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Entity Type | Individual
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Provider Name | JOHN BERTRAND DAVIS MD
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Gender | Male
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 1307 ISABEL DR
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City | SANIBEL
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State | FL
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Zip | 33957-3511
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Country | US
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Telephone | 239-470-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 ISABEL DR
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City | SANIBEL
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State | FL
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Zip | 33957-3511
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Country | US
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Telephone | 239-470-1020
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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 | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 0039739
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | MD.207761
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License Number State | LA
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