Provider Demographics
NPI:1801821129
Name:DAVIDSON, ROBERT MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10762 NW 18TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4206
Mailing Address - Country:US
Mailing Address - Phone:954-594-4822
Mailing Address - Fax:954-757-5344
Practice Address - Street 1:10762 NW 18TH CT
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-4206
Practice Address - Country:US
Practice Address - Phone:954-594-4822
Practice Address - Fax:954-757-5344
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1172213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87667Medicare PIN
T95169Medicare UPIN