MEDICARE: DR. MICHAEL JUDD DAVIS 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	207R00000X	Internal Medicine Physician	H3015	TX
2	207RC0000X	Cardiovascular Disease Physician	H3015	TX

General Provider Information

NPI Number	:	1720388069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JUDD DAVIS M.D.

Provider Business Mailing Address
First Line	:	9450 SW GEMINI DR
Second Line	:	PMB49084
City	:	BEAVERTON
State	:	OR
Zip	:	97008
Country	:	US
Telephone Number	:	713-461-2915
Fax Number	:	713-461-5307

Provider Business Practice Location Address
First Line	:	600 N SHEPHERD DR STE 530
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-4634
Country	:	US
Telephone Number	:	713-461-2915
Fax Number	:	713-461-5307

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

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	10/23/2023

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