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General NPI Number Information
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NPI Number | 1275049637
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Entity Type | Organization
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Legal Business Name | YOUR FAMILY DOCTOR, PLLC
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 12/21/2017
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Provider Practice Location Address
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Address Line | 123 BLUE HERON DR STE 101
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City | MONTGOMERY
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State | TX
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Zip | 77316-3192
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Country | US
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Telephone | 936-582-6000
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Fax | 936-448-6404
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Provider Business Mailing Address
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Address Line | 123 BLUE HERON DR STE 101
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City | MONTGOMERY
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State | TX
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Zip | 77316-3192
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Country | US
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Telephone | 936-582-6000
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Fax | 936-448-6404
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. ANDREW J DAVIS
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Credential | MD
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Telephone | 936-582-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H0285
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License Number State | TX
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