=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427374917
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC ROSS DAVIES M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2010
-----------------------------------------------------
Last Update Date | 07/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2305 GENOA BUSINESS PARK DR SUITE 210
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48114-7004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-494-6881
-----------------------------------------------------
Fax | 810-494-6882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 FRANK LLOYD WRIGHT DR PO BOX 0446 LOBBY J
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48105-9484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | A133534
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 4301096656
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------