Healthcare Provider Details

I. General information

NPI: 1629061726
Provider Name (Legal Business Name): MICHAEL PRENTICE DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 VETERANS MEMORIAL BLVD FL 6
METAIRIE LA
70002-6320
US

IV. Provider business mailing address

1514 JEFFERSON HWY HOSPITALIST GROVE
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-836-9820
  • Fax: 504-846-9608
Mailing address:
  • Phone: 504-349-1656
  • Fax: 504-349-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number025236
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: