Healthcare Provider Details

I. General information

NPI: 1720388069
Provider Name (Legal Business Name): MICHAEL JUDD DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N SHEPHERD DR STE 530
HOUSTON TX
77007-4634
US

IV. Provider business mailing address

9450 SW GEMINI DR PMB49084
BEAVERTON OR
97008
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-2915
  • Fax: 713-461-5307
Mailing address:
  • Phone: 713-461-2915
  • Fax: 713-461-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH3015
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberH3015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: