Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | M D28275 | OR |
NPI | 1063418838 |
---|---|
Provider Name | Craig J Davidson |
First Address | Eugene, OR 97403-1232 |
Second Address | Eugene, OR 97403-1232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 21/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
279253 | (05) | OR |