MEDICARE: MRS. ELAINE M. DAVIDSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	M5546	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010150633	OTHER	ID	BLUE SHIELD
2	74526	OTHER	ID	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093705022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELAINE M. DAVIDSON M.D.

Provider Business Mailing Address
First Line	:	2840 S MERIDIAN RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-7960
Country	:	US
Telephone Number	:	208-593-6393
Fax Number	:	208-593-6402

Provider Business Practice Location Address
First Line	:	2840 S MERIDIAN RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-7960
Country	:	US
Telephone Number	:	208-593-6393
Fax Number	:	208-593-6402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	09/09/2025

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