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NPI Code Detail

MEDICARE: MR. RICHARD ROSS DAVIDSON PA-C

MEDICARE: MR. RICHARD ROSS DAVIDSON PA-C
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
1363A00000XPhysician AssistantPA03726TX

General Provider Information

NPI Number : 1538120225
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD ROSS DAVIDSON PA-C
Provider Business Mailing Address
First Line : 710 OLYMPIA DR
Second Line :
City : DUNCANVILLE
State : TX
Zip : 75137-3822
Country : US
Telephone Number : 972-283-8674
Fax Number :
Provider Business Practice Location Address
First Line : 4500 S LANCASTER RD
Second Line : NORTH TEXAS HEALTH CARE SYSTEM, (1121)
City : DALLAS
State : TX
Zip : 75216-7167
Country : US
Telephone Number : 214-857-1808
Fax Number : 214-857-1840
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2006
Last Update Date : 07/08/2007

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