Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 13613 | TN |
Y | 207VX0000X | Obstetrician | 53209 | AZ |
NPI | 1013910157 |
---|---|
Provider Name | Coleman Wade Davidson II |
First Address | Tucson, AZ 85751-1235 |
Second Address | Tucson, AZ 85712-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 13/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
254811 | (05) | AZ |
53209 | AZ STATE LICENSE (01) | AZ |
B59026 | (02) | TN |