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General NPI Number Information
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NPI Number | 1811977424
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Entity Type | Individual
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Provider Name | SCOTT B DAVIDSON MD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 1105 SIXTH ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2345
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Country | US
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Telephone | 231-935-7514
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Fax | 231-392-0039
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Provider Business Mailing Address
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Address Line | 601 JOHN ST SUITE M452
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City | KALAMAZOO
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State | MI
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Zip | 49007-5341
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Country | US
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Telephone | 269-341-6022
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Fax | 269-341-8244
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301056087
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License Number State | MI
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