Healthcare Provider Details

I. General information

NPI: 1609193697
Provider Name (Legal Business Name): EDWARD H DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 11/24/2023
Certification Date: 11/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N FLAGLER DR STE 6400
WEST PALM BEACH FL
33401-3425
US

IV. Provider business mailing address

1411 N FLAGLER DR STE 6400
WEST PALM BEACH FL
33401-3425
US

V. Phone/Fax

Practice location:
  • Phone: 561-800-3223
  • Fax: 561-879-9388
Mailing address:
  • Phone: 561-800-3223
  • Fax: 561-879-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35.136662
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: