MEDICARE: MR. RICHARD ROSS DAVIDSON PA-C

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	363A00000X	Physician Assistant	PA03726	TX

General Provider Information

NPI Number	:	1538120225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD ROSS DAVIDSON PA-C

Provider Business Mailing Address
First Line	:	710 OLYMPIA DR
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75137-3822
Country	:	US
Telephone Number	:	972-283-8674
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 S LANCASTER RD
Second Line	:	NORTH TEXAS HEALTH CARE SYSTEM, (1121)
City	:	DALLAS
State	:	TX
Zip	:	75216-7167
Country	:	US
Telephone Number	:	214-857-1808
Fax Number	:	214-857-1840

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/08/2007

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