Healthcare Provider Details

I. General information

NPI: 1578583191
Provider Name (Legal Business Name): WILLIAM LARRY DAVIDSON II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 COUNTY ROAD 64
DAPHNE AL
36526
US

IV. Provider business mailing address

PO BOX 7987
MOBILE AL
36670-0987
US

V. Phone/Fax

Practice location:
  • Phone: 251-625-1370
  • Fax: 251-625-1380
Mailing address:
  • Phone: 251-633-0573
  • Fax: 251-633-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number27233
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number27233
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: