MEDICARE: DR. JOHN EVAN DAVIS MD

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
1	208000000X	Pediatrics Physician	0101031673	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	002744	OTHER	ANTHEM BCBS

General Provider Information

NPI Number	:	1699766998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN EVAN DAVIS MD

Provider Business Mailing Address
First Line	:	PO BOX CVPA
Second Line	:
City	:	RICHLANDS
State	:	VA
Zip	:	24641-1102
Country	:	US
Telephone Number	:	276-964-6771
Fax Number	:	276-964-1314

Provider Business Practice Location Address
First Line	:	1 CLINIC DR
Second Line	:
City	:	RICHLANDS
State	:	VA
Zip	:	24641-1102
Country	:	US
Telephone Number	:	276-964-6771
Fax Number	:	276-964-1314

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	02/13/2015

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Directions to “ DR. JOHN EVAN DAVIS MD” Practice Location

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