Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 22567 | AZ |
NPI | 1003809641 |
---|---|
Provider Name | Dr. Robert Clabaugh Davidson |
First Address | Chandler, AZ 85224-5298 |
Second Address | Chandler, AZ 85224-5298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 25/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0800297 | UHC (01) | AZ |
354324 | (05) | AZ |
AZ0381960 | BCBS (01) | AZ |
E59701 | (02) | AZ |