Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | GFE6436 | CA |
NPI | 1023128808 |
---|---|
Provider Name | Dr. Paul Davidson |
First Address | San Rafael, CA 94901-1342 |
Second Address | San Rafael, CA 94901-1342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 20/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A57525 | (02) | |
GFE6436 | CALIFORNIA LICENSE (01) | CA |