Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 00012169 | AL |
Y | 2080P0203X | Pediatric Critical Care Doctor | 12169 | AL |
NPI | 1053352641 |
---|---|
Provider Name | Mrs. Diana L Davidson |
First Address | Huntsville, AL 35804-2705 |
Second Address | Huntsville, AL 35801-3738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 11/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009949800 | (05) | AL |
051098799 | BC PROVIDER NUMBER (01) | AL |
C76626 | (02) | AL |