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General NPI Number Information
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NPI Number | 1568649309
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Entity Type | Organization
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Legal Business Name | WALTER T. DAVISON, M.D., P.A.
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 02/02/2008
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Provider Practice Location Address
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Address Line | 2540 W DUNWOOD RD
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City | GLENDALE
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State | WI
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Zip | 53209-1824
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Country | US
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Telephone | 414-228-8693
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Fax |
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Provider Business Mailing Address
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Address Line | 2540 W DUNWOOD RD
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City | GLENDALE
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State | WI
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Zip | 53209-1824
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Country | US
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Telephone | 414-228-8693
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WATLTER T DAVISON
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Credential | M.D.
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Telephone | 414-228-8698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 26727020
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License Number State | WI
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