Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 27038 | TX |
Y | 1223G0001X | General Practice | 27038 | TX |
Y | 213EG0000X | General Practice | 27038 | TX |
NPI | 1003103920 |
---|---|
Provider Name | Dr. Michael Scot Davis |
First Address | San Antonio, TX 78237-4200 |
Second Address | San Antonio, TX 78237-4200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 26/05/2021 |