Provider Demographics
NPI:1902855265
Name:DAVIS, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:409 GLENWOOD ST STE 500
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-4933
Mailing Address - Country:US
Mailing Address - Phone:254-897-3369
Mailing Address - Fax:254-898-1157
Practice Address - Street 1:409 GLENWOOD ST
Practice Address - Street 2:500
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4933
Practice Address - Country:US
Practice Address - Phone:254-897-3369
Practice Address - Fax:254-898-1157
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2017-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE2532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140044228Medicaid
TX140044228Medicaid
TXC15079Medicare UPIN