Provider Demographics
NPI:1982977047
Name:DAVIDSON, MICHAEL JAY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAY
Last Name:DAVIDSON
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 1:5581 COACH HOUSE CIRCLE
Mailing Address - Street 2:#A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-8676
Mailing Address - Country:US
Mailing Address - Phone:561-347-0955
Mailing Address - Fax:
Practice Address - Street 1:5581 COACH HOUSE CIRCLE
Practice Address - Street 2:#A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-8676
Practice Address - Country:US
Practice Address - Phone:561-347-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine