Healthcare Provider Details

I. General information

NPI: 1306932975
Provider Name (Legal Business Name): HOWARD ANDREW DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 NW 185TH AVE SUITE 207
ALOHA OR
97006-6822
US

IV. Provider business mailing address

1881 NW 185TH AVE SUITE 207
ALOHA OR
97006-6822
US

V. Phone/Fax

Practice location:
  • Phone: 503-690-8195
  • Fax: 503-629-5806
Mailing address:
  • Phone: 503-690-8195
  • Fax: 503-629-5806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD21363
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: