Individual
MARY DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1705 JACKSON ST, RICHMOND, TX 77469-3246
(616) 734-0335
(616) 949-8540
Mailing address
PO BOX 8129, KENTWOOD, MI 49518-8129
(616) 734-0335
(616) 949-8540
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
J5153
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138435613
—
TX
Enumeration date
11/14/2006
Last updated
11/14/2007
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