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General NPI Number Information
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NPI Number | 1427161561
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Entity Type | Individual
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Provider Name | RANDALL P. DAVIDSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1801 ASHLEY CIR
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3362
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Country | US
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Telephone | 270-793-2165
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Fax |
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Provider Business Mailing Address
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Address Line | 535 ROY THOMAS RD
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City | BOWLING GREEN
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State | KY
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Zip | 42103-9087
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Country | US
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Telephone | 270-843-6267
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 31045
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License Number State | KY
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