MEDICARE: DR. JOHN ANTHONY DAVIS PHD 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	207RI0200X	Infectious Disease Physician	092205	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962484725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ANTHONY DAVIS PHD MD

Provider Business Mailing Address
First Line	:	700 ACKERMAN ROAD, SUITE 385
Second Line	:	OSU INTERNAM MEDICINE, LLC
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-947-3700
Fax Number	:	614-947-3771

Provider Business Practice Location Address
First Line	:	456 W 10TH AVE
Second Line	:	DIVISION OF INFECTIOUS DISEASE
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1228
Country	:	US
Telephone Number	:	614-293-5667
Fax Number	:	614-293-4556

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	12/16/2008

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