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General NPI Number Information
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NPI Number | 1124357645
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Entity Type | Organization
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Legal Business Name | ROBERT L. DAVIDSON, M.D. PLLC
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Dates
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Enumeration Date | 12/11/2009
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 520 S EAGLE RD SUITE 1245
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City | MERIDIAN
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State | ID
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Zip | 83642-6351
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Country | US
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Telephone | 208-890-2539
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Fax | 208-939-2698
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Provider Business Mailing Address
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Address Line | 13601 W MCMILLAN RD SUITE 102-311
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City | BOISE
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State | ID
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Zip | 83713-2071
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Country | US
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Telephone | 208-890-2539
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Fax | 208-939-2698
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. ROBERT LANTZ DAVIDSON
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Credential | M.D.
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Telephone | 208-890-9539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | M7907
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License Number State | ID
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