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General NPI Number Information
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NPI Number | 1689788630
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Entity Type | Individual
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Provider Name | DENNON W DAVIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 4105 N WATER TOWER PL
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City | MOUNT VERNON
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State | IL
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Zip | 62864-6296
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Country | US
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Telephone | 618-244-9495
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Fax | 618-244-9497
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Provider Business Mailing Address
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Address Line | 4105 N WATER TOWER PL
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City | MOUNT VERNON
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State | IL
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Zip | 62864-6296
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Country | US
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Telephone | 618-244-9495
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Fax | 618-244-9497
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036099669
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License Number State | IL
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