MEDICARE: DR. DAVIDA ELIZABETH MANOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	L9795	TX
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	2240771	NY
3	207P00000X	Emergency Medicine Physician	L9795	TX

General Provider Information

NPI Number	:	1427138114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVIDA ELIZABETH MANOR M.D.

Provider Business Mailing Address
First Line	:	1240 W 22ND ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1808
Country	:	US
Telephone Number	:	917-678-0104
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 W 22ND ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1808
Country	:	US
Telephone Number	:	917-678-0104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	12/19/2023

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