Provider Demographics
NPI:1306833801
Name:DAVIDSON, JOHN ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALBERT
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63006-0929
Mailing Address - Country:US
Mailing Address - Phone:314-205-6818
Mailing Address - Fax:314-205-6770
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:DIVISION OF HYPERBARIC MEDICINE & PROBLEM WOUND MGMT
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3417
Practice Address - Country:US
Practice Address - Phone:314-205-6818
Practice Address - Fax:314-205-6770
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8881207R00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO35170OtherGROUP HEALTH PLAN
MO4409OtherCARE MGMT RESOURCES
MO7600560OtherUNITED HEALTHCARE MIDWEST
MO7992OtherBLUE SHIELD MO
MOA09884OtherMERCY HEALTH PLAN
MO105889OtherHEALTHLINK PPO
MO35583OtherBLUE SHIELD MO
MOA09884OtherMERCY HEALTH PLAN