Healthcare Provider Details

I. General information

NPI: 1902303696
Provider Name (Legal Business Name): ERIC MICHAEL DAVIED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 10/11/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 S SEGUIN AVE BLDG E
NEW BRAUNFELS TX
78130-3914
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 830-626-7770
  • Fax: 855-347-6311
Mailing address:
  • Phone: 561-570-5172
  • Fax: 786-472-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM3206
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: