MEDICARE: WALTER T. DAVISON, M.D., P.A.

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	2084P0800X	Psychiatry Physician	26727020	WI

General Provider Information

NPI Number	:	1568649309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER T. DAVISON, M.D., P.A.

Provider Business Mailing Address
First Line	:	2540 W DUNWOOD RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-1824
Country	:	US
Telephone Number	:	414-228-8693
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 W DUNWOOD RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-1824
Country	:	US
Telephone Number	:	414-228-8693
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WATLTER T DAVISON
Credential	:	M.D.
Telephone Number	:	414-228-8698

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	02/02/2008

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