Individual
DR. MICHAEL ROBERT DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7900 W JEFFERSON BLVD STE 306, FORT WAYNE, IN 46804-4128
(260) 458-3610
(260) 458-3611
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
01053296A
IN
208200000X
Plastic Surgery Physician
26620
AL
208200000X
Plastic Surgery Physician
P1857
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009941891
—
AL
05
—
009941892
—
AL
05
—
009942208
—
AL
01
—
051540215
BCBS
AL
01
—
051540216
BCBS
AL
01
—
051540217
BCBS
AL
Enumeration date
11/07/2006
Last updated
04/19/2018
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