Healthcare Provider Details

I. General information

NPI: 1073189155
Provider Name (Legal Business Name): STEPHEN MICHAEL DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

7427 SW COHO CT STE 200
TUALATIN OR
97062-9749
US

V. Phone/Fax

Practice location:
  • Phone: 520-327-5461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD228750
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number67532
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.MD.70079833
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: