Healthcare Provider Details

I. General information

NPI: 1912438631
Provider Name (Legal Business Name): MICHAEL ROBERT DAVIES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OWENS ST # 3004
SAN FRANCISCO CA
94158-2334
US

IV. Provider business mailing address

500 PARNASSUS AVE MU 320 WEST
SAN FRANCISCO CA
94143-2203
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2808
  • Fax:
Mailing address:
  • Phone: 415-353-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA159733
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA159733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: