Provider Demographics
NPI:1730576927
Name:DAVITT, JOHN MATHER
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MATHER
Last Name:DAVITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 N 16TH ST STE B101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5274
Mailing Address - Country:US
Mailing Address - Phone:602-358-8588
Mailing Address - Fax:602-688-6991
Practice Address - Street 1:702 E BELL RD STE 119
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6639
Practice Address - Country:US
Practice Address - Phone:602-358-8588
Practice Address - Fax:602-688-6991
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ58112207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program