MEDICARE: DR. JONATHAN SAM 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	207R00000X	Internal Medicine Physician	G66389	CA
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	G66389	CA
3	207RG0100X	Gastroenterology Physician	G66389	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295891224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN SAM DAVIDSON M.D.

Provider Business Mailing Address
First Line	:	1658 CITADELLA DR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95747-5022
Country	:	US
Telephone Number	:	916-699-8592
Fax Number	:

Provider Business Practice Location Address
First Line	:	2288 AUBURN BLVD STE 101
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-1619
Country	:	US
Telephone Number	:	916-699-8592
Fax Number	:

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	08/22/2025

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