MEDICARE: GARY LEE DAVIS MD

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	207P00000X	Emergency Medicine Physician	4301050358	MI

General Provider Information

NPI Number	:	1689680589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY LEE DAVIS MD

Provider Business Mailing Address
First Line	:	200 OCEANGATE
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4217
Country	:	US
Telephone Number	:	562-499-6191
Fax Number	:	562-499-6171

Provider Business Practice Location Address
First Line	:	4700 SCHAEFER RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48123-3698
Country	:	US
Telephone Number	:	313-581-2600
Fax Number	:	313-581-0228

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	01/18/2017

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