Healthcare Provider Details

I. General information

NPI: 1700270832
Provider Name (Legal Business Name): NAOMI MICHELLE DAVIDSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAOMI MICHELLE GUY

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST
RENTON WA
98055-5714
US

IV. Provider business mailing address

PO BOX 26730
FEDERAL WAY WA
98093-3730
US

V. Phone/Fax

Practice location:
  • Phone: 253-661-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC7-0005868
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number031.0119594
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberOP61030552
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: