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General NPI Number Information
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NPI Number | 1184631095
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Entity Type | Individual
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Provider Name | ROBERT M DAVIDSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 212 S SULLIVAN AVE
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City | FREMONT
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State | MI
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Zip | 49412-1548
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Country | US
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Telephone | 231-924-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 EMBASSY DR SE STE 400
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2416
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Country | US
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Telephone | 616-975-1845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4301077336
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01095350A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 4301077336
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License Number State | MI
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