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General NPI Number Information
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NPI Number | 1881009835
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Entity Type | Individual
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Provider Name | JESSE T DAVIDSON IV MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2014
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 1 BARNES JEWISH HOSPITAL PLZ DIV SURG TRANSPLANT
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1003
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Country | US
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Telephone | 314-747-9889
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Fax | 314-361-4197
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Provider Business Mailing Address
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Address Line | PO BOX 60352
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City | SAINT LOUIS
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State | MO
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Zip | 63160-0352
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Country | US
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Telephone | 314-747-9889
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Fax | 314-361-4197
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2016008739
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 204F00000X
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Taxonomy Name | Transplant Surgery Physician
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License Number | 036169278
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License Number State | IL
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