Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301077336 | MI |
NPI | 1184631095 |
---|---|
Provider Name | Robert M Davidson |
First Address | Chicago, IL 60689-5325 |
Second Address | Fremont, MI 49412-1548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 09/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
930117102 | RAILROAD MEDICARE (01) | MI |
A74760 | (02) | MI |