Healthcare Provider Details

I. General information

NPI: 1063451318
Provider Name (Legal Business Name): ROBERT S. DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0002
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 656
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5282
  • Fax: 585-273-1068
Mailing address:
  • Phone: 585-275-5282
  • Fax: 585-273-1068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number112049
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: