Provider Demographics
NPI:1013063437
Name:MICHELSON, DAVID SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:MICHELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9834 GENESEE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1223
Mailing Address - Country:US
Mailing Address - Phone:858-457-3050
Mailing Address - Fax:858-457-0851
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1223
Practice Address - Country:US
Practice Address - Phone:858-457-3050
Practice Address - Fax:858-457-0851
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA065692207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA065692OtherSTATE LICENSE NUMBER
CAA065692OtherSTATE LICENSE NUMBER
CAW14326Medicare ID - Type Unspecified