Healthcare Provider Details

I. General information

NPI: 1003809641
Provider Name (Legal Business Name): ROBERT CLABAUGH DAVIDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 W FRYE RD STE 220
CHANDLER AZ
85224-5298
US

IV. Provider business mailing address

1727 W FRYE RD STE 220
CHANDLER AZ
85224-5298
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-1800
  • Fax: 480-821-6749
Mailing address:
  • Phone: 480-821-1800
  • Fax: 480-821-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number22567
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number22567
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: