Provider Demographics
NPI:1235107889
Name:DAVIS, ERIC B (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 SWEETWATER BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3148
Mailing Address - Country:US
Mailing Address - Phone:281-265-1100
Mailing Address - Fax:281-265-1121
Practice Address - Street 1:4760 SWEETWATER
Practice Address - Street 2:SUITE 104
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3845
Practice Address - Country:US
Practice Address - Phone:281-265-1100
Practice Address - Fax:281-265-1121
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4957174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15077Medicare UPIN
TX00637HMedicare PIN