Healthcare Provider Details
I. General information
NPI: 1407502867
Provider Name (Legal Business Name): BRIDGETTE L. DAVIDSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 02/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
US DEPARTMENT OF VETERAN AFFAIRS- OFFICE OF PSYCHIATRIS 1901 VETERAN MEMORIAL BLVD BLG147
TEMPLE TX
76504
US
IV. Provider business mailing address
US DEPARTMENT OF VETERAN AFFAIRS- OFFICE OF PSYCHIATRIS 1901 VETERAN MEMORIAL BLVD BLG147
TEMPLE TX
76504
US
V. Phone/Fax
- Phone: 254-743-2867
- Fax:
- Phone: 254-743-2867
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084A0401X |
| Taxonomy | Addiction Medicine (Psychiatry & Neurology) Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084A2900X |
| Taxonomy | Neurocritical Care Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084B0040X |
| Taxonomy | Behavioral Neurology & Neuropsychiatry Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084D0003X |
| Taxonomy | Diagnostic Neuroimaging (Psychiatry & Neurology) Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084E0001X |
| Taxonomy | Epilepsy Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084H0002X |
| Taxonomy | Hospice and Palliative Medicine (Psychiatry & Neurology) Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084N0008X |
| Taxonomy | Neuromuscular Medicine (Psychiatry & Neurology) Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084N0600X |
| Taxonomy | Clinical Neurophysiology Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0015X |
| Taxonomy | Psychosomatic Medicine Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0301X |
| Taxonomy | Brain Injury Medicine (Psychiatry & Neurology) Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0805X |
| Taxonomy | Geriatric Psychiatry Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P2900X |
| Taxonomy | Pain Medicine (Psychiatry & Neurology) Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084S0012X |
| Taxonomy | Sleep Medicine (Psychiatry & Neurology) Physician |
| License Number | L4446493 |
| License Number State | TX |
| # 14 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084B0002X |
| Taxonomy | Obesity Medicine (Psychiatry & Neurology) Physician |
| License Number | L4446493 |
| License Number State | TX |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
