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NPI Code Detail

MEDICARE: DR. JOHN K DAVIS DO

MEDICARE: DR. JOHN K DAVIS DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician3192AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2AZ0728670OTHERAZBLUECROSS/BLUESHIELD GRP
3AW1436OTHERAZHEALTHNET GROUP
439-87220OTHERAZEVERCARE GROUP

General Provider Information

NPI Number : 1093796104
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN K DAVIS DO
Provider Business Mailing Address
First Line : 2390 SATTERFIELD DR
Second Line :
City : POCATELLO
State : ID
Zip : 83201-7905
Country : US
Telephone Number : 208-238-0235
Fax Number :
Provider Business Practice Location Address
First Line : 2735 SILVER CREEK RD
Second Line :
City : BULLHEAD CITY
State : AZ
Zip : 86442-7924
Country : US
Telephone Number : 928-763-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 01/07/2008

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