MEDICARE: CRAIG J DAVIDSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	M D28275	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063418838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG J DAVIDSON M.D.

Provider Business Mailing Address
First Line	:	1232 UNIVERSITY OF OREGON
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97403-1232
Country	:	US
Telephone Number	:	541-346-0565
Fax Number	:	541-346-2748

Provider Business Practice Location Address
First Line	:	1232 UNIVERSITY OF OREGON
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97403-1232
Country	:	US
Telephone Number	:	541-346-0565
Fax Number	:	541-346-2748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	11/21/2012

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