Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | A32633 | CA |
NPI | 1063547644 |
---|---|
Provider Name | Dr. Bert J. Davidson |
First Address | Colton, CA 92324-1801 |
Second Address | Colton, CA 92324-1801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A26872 | (02) | CA |