Healthcare Provider Details

I. General information

NPI: 1891292033
Provider Name (Legal Business Name): SEAN RICHARD DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE BLUE PKWY
LEES SUMMIT MO
64063-1007
US

IV. Provider business mailing address

2525 MAIN ST
KANSAS CITY MO
64108-2673
US

V. Phone/Fax

Practice location:
  • Phone: 469-688-4710
  • Fax:
Mailing address:
  • Phone: 469-688-4710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberV0378
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: