Davidson, Brent Ryan

Davidson, Brent Ryan is an individual health care provider with primary practice located at 1011 Bowles Ave Suite 415, Fenton MO 63026-2395. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Davidson, Brent Ryan can be contacted via phone (636) 717-1700.

Contact Information

Primary practice address
1011 Bowles Ave Suite 415 Fenton MO 63026-2395
Phone: (636) 717-1700
Fax: (636) 203-4727
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 2005009915 Missouri

Profile Details

NPI number 1437127065
LBN Legal business name Davidson, Brent Ryan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 9th, 2006
Last updated Jan 23rd, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1437127065 NPPES
Illinois Other 10032015 BLUECROSS BLUESHIELD
Illinois Other P00339415 BLUECROSS BLUESHIELD
Illinois Other 714579 BLUECROSS BLUESHIELD
Illinois Other 714579 BLUECROSS BLUESHIELD
Illinois Other 109208 BLUECROSS BLUESHIELD
Illinois Other P00238356 BLUECROSS BLUESHIELD
Illinois Other 113109 BLUECROSS BLUESHIELD
Illinois Other 226523 BLUECROSS BLUESHIELD
Illinois MEDICAID 207319807 BLUECROSS BLUESHIELD
Illinois Other 5617586 BLUECROSS BLUESHIELD
Illinois Other 753168118 BLUECROSS BLUESHIELD
Illinois Other 199422 BLUECROSS BLUESHIELD

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