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General NPI Number Information
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NPI Number | 1528040367
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Entity Type | Individual
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Provider Name | PHILIP A DAVIDSON MEDICAL DOCTOR
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Gender | Male
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 2200 PARK AVE BLDG D STE 100
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City | PARK CITY
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State | UT
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Zip | 84060-7246
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Country | US
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Telephone | 435-615-8822
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Fax | 435-615-8823
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Provider Business Mailing Address
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Address Line | 2200 PARK AVE BLDG D STE 100
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City | PARK CITY
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State | UT
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Zip | 84060-7246
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Country | US
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Telephone | 435-615-8822
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Fax | 435-615-8823
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | ME54865
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License Number State | FL
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