Healthcare Provider Details

I. General information

NPI: 1376500579
Provider Name (Legal Business Name): JONATHAN MERLIN DAVISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
TACOMA WA
98431-1000
US

IV. Provider business mailing address

9040 JACKSON AVE MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1645
  • Fax:
Mailing address:
  • Phone: 253-968-1645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01055856A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number01055856A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: