NPIMap

Organization Active NPI

Michael S Davidov, MD, Inc, PS

  • Obstetrics & Gynecology Physician
  • Federal Way, WA
National Provider Identifier
1174831192
Registry record updated Dec 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD00034406 Issued in WA
Legal business name
MICHAEL S DAVIDOV, MD, INC, PS
Practice address
34509 9TH Avenue South
#207
Federal Way, WA 98003-8709
Phone
(253) 815-9595
Fax
(253) 815-9797
NPI assigned
Sep 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael S Davidov, MD
Title
President
Phone
(253) 815-9595

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X MD00034406 WA Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X MD00034406 WA

Addresses

Primary practice location

34509 9TH Avenue South
#207
Federal Way, WA 98003-8709

Mailing address

34509 9TH Avenue South
#207
Federal Way, WA 98003-8709
Phone (253) 815-9595

Other identifiers 3

IdentifierTypeStateIssuer
GAB20523OtherWAPTAN
1113661MedicaidWA
7900749MedicaidWA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292457600000",
    "number": "1174831192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34509 9TH AVENUE SOUTH",
            "address_2": "#207",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038709",
            "telephone_number": "253-815-9595",
            "fax_number": "253-815-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34509 9TH AVENUE SOUTH",
            "address_2": "#207",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038709",
            "telephone_number": "253-815-9595",
            "fax_number": "253-815-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL S DAVIDOV, MD, INC, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-24",
        "last_updated": "2010-12-16",
        "status": "A",
        "authorized_official_last_name": "DAVIDOV",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-815-9595",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "WA",
            "license": "MD00034406",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "WA",
            "license": "MD00034406",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "GAB20523",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1113661",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7900749",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.