Healthcare Provider Details

I. General information

NPI: 1801820774
Provider Name (Legal Business Name): RICHARD S DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

237 26TH STREET
OGDEN UT
84401-3105
US

IV. Provider business mailing address

237 26TH STREET
OGDEN UT
84401-3105
US

V. Phone/Fax

Practice location:
  • Phone: 801-625-3605
  • Fax: 801-625-3615
Mailing address:
  • Phone: 801-625-3605
  • Fax: 801-625-3615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1642288905
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: