Healthcare Provider Details

I. General information

NPI: 1295792497
Provider Name (Legal Business Name): JEFFREY MITCHEL DAVIDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MONTGOMERY ST SUITE 2370
SAN FRANCISCO CA
94104-4205
US

IV. Provider business mailing address

180 MONTGOMERY ST SUITE 2370
SAN FRANCISCO CA
94104-4205
US

V. Phone/Fax

Practice location:
  • Phone: 415-433-6673
  • Fax: 415-433-6063
Mailing address:
  • Phone: 415-433-6673
  • Fax: 415-433-6063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG52139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: