Healthcare Provider Details

I. General information

NPI: 1326019225
Provider Name (Legal Business Name): RANDAL DAVID DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 E I20 SUITE 30G
ARLINGTON TX
76012
US

IV. Provider business mailing address

PO BOX 120069
ARLINGTON TX
76012
US

V. Phone/Fax

Practice location:
  • Phone: 817-465-1171
  • Fax: 817-465-6044
Mailing address:
  • Phone: 817-274-1999
  • Fax: 817-274-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH0284
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: