=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205284619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHA DAVIDSON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2016
-----------------------------------------------------
Last Update Date | 08/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6431 FANNIN ST STE MSB 3126
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-1501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-500-5714
-----------------------------------------------------
Fax | 713-500-5805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6431 FANNIN ST SUITE MSB 3.151
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-1501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-500-5800
-----------------------------------------------------
Fax | 713-500-5805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number | S1794
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------