Provider Demographics
NPI:1811977424
Name:DAVIDSON, SCOTT B (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:B
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M452
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-6022
Mailing Address - Fax:269-341-8244
Practice Address - Street 1:1105 SIXTH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2345
Practice Address - Country:US
Practice Address - Phone:231-935-7514
Practice Address - Fax:231-392-0039
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2024-09-27
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Provider Licenses
StateLicense IDTaxonomies
MI4301056087208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICA2184OtherRAILROAD MEDICARE
MI4575043Medicaid
MI4575043Medicaid
MICA2184OtherRAILROAD MEDICARE