Healthcare Provider Details

I. General information

NPI: 1639331960
Provider Name (Legal Business Name): TODD L DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 BATTERSBY AVE
ENUMCLAW WA
98022-3634
US

IV. Provider business mailing address

7502 SNOWBERRY AVE SE
SNOQUALMIE WA
98065-8978
US

V. Phone/Fax

Practice location:
  • Phone: 406-579-6860
  • Fax:
Mailing address:
  • Phone: 406-579-6860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60217471
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: