Healthcare Provider Details

I. General information

NPI: 1073189155
Provider Name (Legal Business Name): STEPHEN MICHAEL DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13677 W MCDOWELL RD
GOODYEAR AZ
85395-2600
US

IV. Provider business mailing address

PO BOX 18892
BELFAST ME
04915-4083
US

V. Phone/Fax

Practice location:
  • Phone: 623-882-1500
  • Fax: 623-882-1912
Mailing address:
  • Phone: 844-597-5702
  • Fax: 888-902-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD228750
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number67532
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.MD.70079833
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: