Healthcare Provider Details

I. General information

NPI: 1427161561
Provider Name (Legal Business Name): RANDALL P. DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ASHLEY CIR
BOWLING GREEN KY
42104-3362
US

IV. Provider business mailing address

535 ROY THOMAS RD
BOWLING GREEN KY
42103-9087
US

V. Phone/Fax

Practice location:
  • Phone: 270-793-2165
  • Fax:
Mailing address:
  • Phone: 270-843-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number31045
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: