MEDICARE: DR. KIM MARIE 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	207Q00000X	Family Medicine Physician	FLME0056564	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68502	OTHER	FL	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568450773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM MARIE DAVIDSON M.D.

Provider Business Mailing Address
First Line	:	23343 NW COUNTY ROAD 236
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32643-9669
Country	:	US
Telephone Number	:	386-454-0698
Fax Number	:	386-454-0690

Provider Business Practice Location Address
First Line	:	23476 W US HIGHWAY 27
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32643
Country	:	US
Telephone Number	:	386-454-0568
Fax Number	:	352-224-7899

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/10/2019

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